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Hospital context in surgical site infection following colorectal surgery: a multi-level logistic regression analysis

  • Rui Malheiro
    Correspondence
    Corresponding author. , , Tel.: +351 914 311 311 EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 3050-091 Porto, Portugal.
    Affiliations
    EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

    Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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  • Bárbara Peleteiro
    Affiliations
    EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

    Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal

    Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
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  • Goreti Silva
    Affiliations
    Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde (Directorate General of Health), Lisboa, Portugal
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  • Ana Lebre
    Affiliations
    Instituto Português de Oncologia do Porto Francisco Gentil, E. P. E., Porto, Portugal

    Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde (Directorate General of Health), Lisboa, Portugal
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  • José Artur Paiva
    Affiliations
    Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde (Directorate General of Health), Lisboa, Portugal

    Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal

    Department of Medicine, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
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  • Sofia Correia
    Affiliations
    Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
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Published:November 19, 2022DOI:https://doi.org/10.1016/j.jhin.2022.11.004

      Highlights

      • What is already known on this topic: Although many risk factors have been identified for surgical site infection after colorectal surgery, the role of hospital determinants is unknown and no research has been published using the appropriate multi-structured hierarchical data.
      • What this study adds: There is heterogeneity in surgical site infection incidence between hospitals. Known risk factors and hospital dimension explain a substantial part of the variance, yet other variables are required to account for the entire variance of infection incidence.
      • How this study might affect research, practice or policy: Hospital dimension should be considered when establishing goals for infection prevention. Hospital determinants should not be undervalued and should be included in future research to develop optimal strategies for infection prevention and control.

      Summary

      Background

      Surgical site infections (SSI) are associated with poor health outcomes. Their incidence is highest after colorectal surgery, with little improvement in recent years. The role of hospital characteristics is undetermined. Thus, our aim was to investigate whether SSI incidence after colorectal surgery varies between hospitals, and whether such variance may be explained by hospital characteristics.

      Methods

      Data were retrieved from the electronic platform of the Directorate General of Health, from 2015 to 2019. Hospital characteristics were retrieved from publicly available data on the Portuguese public administration. Analysis considered a two-level hierarchical data structure, with individuals clustered in hospitals. To avoid overfitting, no models were built with more than one hospital characteristic. Cluster level associations are presented through median odds ratio (MOR) and intraclass cluster coefficient (ICC). Beta coefficients were used to assess the contextual effects.

      Results

      A total of 11 219 procedures from 18 hospitals were included. The incidence of SSI was 16.8%. The ICC for the null model was 0.09. Procedural variables explained 25% of the variance, and hospital dimension explained another 17%. Over 50% of SSI variance remains unaccounted for. After adjustment, heterogeneity between hospitals (MOR: 1.51, ICC: 0.05) was still found. No hospital characteristic was significantly associated with SSI.

      Conclusion

      Procedural variables and hospital dimension explain almost half of SSI variance and should be taken into account when implementing prevention strategies. Future research should focus on compliance with preventive bundles and other process indicators in hospitals with significantly less SSI in colorectal surgery.

      Keywords

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