SURGICAL-SITE INFECTION-RATES IN PATIENTS WHO UNDERGO ELECTIVE SURGERY ON THE SAME-DAY AS THEIR HOSPITAL ADMISSION

OBJECTIVE: To follow over time surgical-site infection (SSI) rates in patients admitted to the hospital on the same day as their elective su rgery (group I), and to compare these rates with those of other surgic al patients who also required postoperative hospitalization but either were hospitalized for 1 or more days immediately prior to surgery or underwent surgery on a nonelective basis (group II). DESIGN: Observati on of overall SSI rates over time for group I and II patients and stud y of risk factors associated with increased SSI rate among group I neu rosurgical patients. SETTING: A 900-bed, tertiary-care community hospi tal with >10,000 surgical procedures performed each year on patients r equiring postoperative hospital stay.PATIENTS: A total of 48,464 surgi cal procedures were performed on consecutive patients from 1990 to 199 4, with 18,794 (39%) involving group I patients. In addition, 511 cons ecutive procedures performed on neurosurgical patients requiring posto perative hospitalization from July 1994 to May 1995 were analyzed. RES ULTS: In 1990, the overall SSI rate of group I patients was significan tly lower than that of group II patients (0.4% vs 1.3%, relative risk [RR], 3.6; 95% confidence interval [CI95], 2-6.4; P<.0001), but, by 19 94, there was no longer any significant difference between the SSI rat es of group I and II patients (1.8% and 1.6%, respectively; P=.38). In 1994, the SSI rate in group I neurosurgical patients was significantl y greater than that of group II patients 3.4% vs 0.4%; RR, 8.3; CI95, 1.05-66; P=.02). During the period April through September 1994 (warm months), group I neurosurgical patients were associated with a signifi cantly lower American Society of Anesthesiologists score and SSI risk index (based on National Nosocomial Infection Surveillance System data ) and a higher likelihood of having ''clean-class'' wounds, but signif icantly greater-than-expected SSI rate when adjusted for patient risk index and type of procedure (4.7% vs 1.4%; RR, 3.3; CI95, 1.3-8.6; P=. 02). During the same period, the observed and expected SSI rates were not significantly different for group II neurosurgical patients. CONCL USIONS: As a whole, the SSI rates among patients undergoing elective s urgery on the same day of their hospital admission is no longer signif icantly lower than that of other patients who also require postoperati ve hospitalization. For certain procedures, such as those commonly per formed on the neurosurgical service, elimination of preoperative hospi tal stay may be associated with greater-than-expected risk of SSI.