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

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 or 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.