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The Incidence of Post-discharge Surgical Site Infection in the Injured Patient

McIntyre, Lisa K. MD; Warner, Keir J. BS; Nester, Theresa A. MD; Nathens, Avery B. MD

The Journal of Trauma: Injury, Infection, and Critical Care: February 2009 - Volume 66 - Issue 2 - p 407-410
doi: 10.1097/TA.0b013e318173f833
Original Articles

Background: Approximately 50% of surgical site infections (SSI) after elective surgery occur after discharge. Adequate surveillance for these infections requires a mechanism for post-discharge follow up. The incidence of SSI after injury is as high as 30%. As post-discharge follow up in the trauma population is difficult, we set out to ascertain the incidence of post-discharge SSI in a cohort of high-risk trauma patients.

Methods: Patients (n = 268) enrolled in a randomized controlled trial of leukoreduced versus regular blood transfusions were evaluated either in person or by structured telephone survey 28 days after admission regarding the presence of SSI. Inclusion criteria were age >17 years and blood transfusion within 24 hours of injury.

Results: Among the 268 patients, 39 (15%) developed a SSI. There were 27 SSI identified in hospital and 13 identified in the post-discharge period after a median length of stay of 17 days (one patient had more than one SSI). Although the 13 patients who developed a SSI in the post-discharge period comprised only 7% (13 of 194) of the cohort that had at least one operative procedure and survived to discharge, these patients represented 33% (13 of 39) of all patients who developed a SSI.

Conclusion: Despite their prolonged length of stay compared with elective surgical patients, a significant proportion of SSI after injury occurs after discharge. These data support the need for a post-discharge surveillance system in either clinical trials or for quality assurance.

From the Department of Surgery (L.K.M., K.J.W.), Puget Sound Blood Center (T.A.N.), University of Washington, Harborview Medical Center, Seattle, Washington; and Division of General Surgery and Trauma (A.B.N.), St. Michael’s Hospital and the Department of Surgery, the University of Toronto, Ontario, Canada.

Submitted for publication June 19, 2007.

Accepted for publication March 13, 2008.

Supported by funding from the National Institutes of Health (NIH NIGMS R01 GM66117-01 and NIH NHLBI 1 P50 HL073996-01) and from the Government of Canada (Canada Research Chair [to A.B.N.]).

Presented at Surgical Infection Society, La Jolla, California, 2006.

Address for reprints: Lisa K. McIntyre, MD, Box 359796, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104; email:

© 2009 Lippincott Williams & Wilkins, Inc.