Abstract
Introduction Surgical site infection (SSI) is a key performance indicator to assess the quality
of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking
in the literature.
Aim To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery
centre.
Materials and Methods This is a prospective cohort study of all the neonates who underwent abdominal and
thoracic surgery between March 2012 and October 2016. The variables analyzed were
gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal
intensive care unit, type of surgery, length of stay, and microorganisms isolated
from the wounds. Statistical analysis was done with chi-square, Student's t- or Mann–Whitney U-tests. A logistic regression model was used to evaluate determinants of risk for
SSI; variables were analyzed both with univariate and multivariate models. For the
length of hospital stay, a logistic regression model was performed with independent
variables.
Results A total of 244 neonates underwent 319 surgical procedures. The overall incidence
of SSIs was 43/319 (13.5%). The only statistical differences between neonates with
and without SSI were preoperative stay (<4 days vs. ≥4 days, p < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p < 0.01). A pre-operative stay longer than 4 days was associated with almost three
times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05–8.34,
p = 0.0407). Gastrointestinal procedures were associated with more than ten times the
risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82–27.10, p < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies
had the highest incidence SSI (54% and 62%, respectively). The risk of longer length
of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63–6.94,
p = 0.001).
Conclusion This is the first article benchmarking the incidence of SSI in neonatal surgery in
the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were
independent risk factors for SSI. More research is needed to develop strategies to
reduce SSI in selected neonatal procedures.
Keywords
neonatal surgery - surgical site infection - risk factor - outcome
