In-House Delay of Elective Surgery May Increase Infection Risk

In-hospital delay of elective surgery is linked to significant increases in infectious complications, mortality, and hospital costs, according to the results of a new study.

Researchers at the University of Medicine and Dentistry (UMDNJ; New Brunswick, NJ, USA) queried the US nationwide inpatient sample between 2003 and 2007 to identify patients who had developed postoperative infectious complications. In all, there were 87,318 coronary artery bypass graft (CABG) procedures, 46,728 colon resections, and 28,960 lung resections evaluated. The time to elective surgery in days from admission was divided into 0, 1 day, 2-5 days, and 6-10 day categories. The infectious complications evaluated included pneumonia, urinary tract infections, postoperative sepsis, and surgical site infections (SSIs).

The results showed that total infection rates significantly increased after elective surgery delays: For CABG: 0 days, 5.73%; 1 day, 6.68%; 2-5 days, 9.33%; and 6-10 days,18.24%.
For colon resections: 0 days, 8.43 %; 1 day, 11.86%; 2-5 days, 15.79%; and 6-10 days, 21.62%. For lung resections: 0 days, 10.17%; 1 day, 14.53%; 2-5 days, 15.53%; and 6-10 days, 20.56%.

Trends for increasing infections after delay were significant for pneumonia and sepsis for all procedures; urinary tract infections and SSIs significantly increased after CABG and colon resection. Age 80 years and older, female gender, black and Hispanic race or ethnicity, and comorbidities including congestive heart failure (CHD), chronic pulmonary disease (CPD), and renal failure were associated with delay in surgery. Postoperative hospital mortality after delayed procedures was also greater. The study was published in the December 2010 issue of the Journal of the American College of Surgeons.

"Multiple factors can contribute to postsurgical complications, including age and coexisting health issues,” said lead author Todd Vogel, MD, MPH. "This analysis, however, confirms a direct correlation between delaying procedures and negative patient outcomes. As pay-for-performance models become increasingly prevalent, it will be imperative for hospitals to consider policies aimed at preventing delays and thereby reducing infection rates.”

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