Having Elective Surgery?…..Get in and Get Out!

Every year tens of millions of people undergo elective surgeries in U.S. hospitals (40 million in 2000 according to the National Office for Health Statistics). The term “elective” refers to a pre-planned, non emergency surgical procedure. Due to advances in modern medicine, over half of elective surgeries are now performed on an outpatient basis, meaning the patient is admitted and discharged in the same day, without the need for an overnight stay in the hospital. However, even with these surgical advances, there remains a significant risk of developing a surgical site infection (SSI) after an elective procedure.

SSI’s are a major subset of hospital-acquired infections and represent a serious burden to healthcare systems worldwide. In addition to the obvious threat to life and extended patient suffering, SSI’s add significant costs to patient care. While a minor post-surgical infection may add $5000-$10,000, SSI’s after major procedures (e.g. orthopedic or cardiac) increase the patient cost of care by well over $100,000 per case.1 With these numbers, it’s easy to see how even hospitals with relatively low infection rates can lose millions of dollars every year to SSI’s. The occurrence of SSI’s is dependent on a variety of factors, including the type of surgery, whether the patient is colonized with specific strains of bacteria prior to the procedure, the skill of the surgeon, and potential bacterial contamination of the surgical site before/during the procedure. It shouldn’t be surprising to hear that Staphylococcus aureus, and its antibiotic-resistant variant MRSA, is the most common cause of SSI’s.

An interesting study related to the development of SSI’s was recently reported by doctors from New Jersey at the Annual Meeting of the Surgical Infection Society.2 This group evaluated the impact of delays to elective surgery on the risk of developing an SSI. After looking back at over 150,000 procedures performed between 2003 and 2007 in three subspecialties (coronary artery bypass graft, colon resection, and lung resection), it was found that surgery delays after admission resulted in a significantly elevated risk of infection related complications and death. In fact, while post-operative infectious complications were seen in only 5-10% of cases when surgery was performed on the day of admission, this risk was elevated to more than 20% with delays of more than 6 days. Admittedly, the probability of a six day delay to surgery after admission is very low, but even shorter delays in the 1-2 day range were found to significantly increase the chances of infection. In this particular study delays were primarily caused by co-morbitities (ie. other things wrong with patients at the time of surgery) and were experienced more commonly in females, older patients, and minority groups.

Basically, what this study is telling us is that the longer you have to stay admitted to a hospital the greater your chance of developing infectious complications. Interestingly, it seems that this holds true for time spent on the front-end of your medical procedure as well as on the back-end. Advances in surgical techniques have allowed patients to leave the hospital after an operation much quicker today than ever before, greatly reducing the odds of developing a hospital-acquired infection from MRSA or other bacterial strains. However, care should also be taken to avoid any unnecessary delays before elective surgery as well if possible. And remember….while it may seem discomforting to some to be processed quickly and then “booted out” of the hospital right after a procedure, you can trust that getting out of there as soon as possible is in your best interest in these times of superbugs and antibiotic-resistance.

1 Noskin et al. (2005) Archives of Internal Medicine 165:1756-1761

2 Vogel at al. (2010) Journal of the American College of Surgeons 211(6):784-790

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One Response to “Having Elective Surgery?…..Get in and Get Out!”

  1. Mizuki says:

    This, for me, was the money quote:”In most cases, surgeons are not tugaht how to teach anything, let alone surgical skills. For many years, it has just been assumed that any surgeon (or any doctor in any specialty) is an excellent teacher. Of course, this is not so. However, teaching is not particularly valued or rewarded an academic medicine. On the other hand research is, especially research that brings in grant money.”Although I’m not entering a surgical residency, I think the teaching emphasis and capabilities should never be under appreciated. Many applicants are attracted to big-name training facilities busting at the seams with grant money and research opportunity (I am arguably entering one, myself). That’s fine, but probably not ideal for residency, during which time the focus should really be on honing your skills as a surgeon or, in my case, clinician (especially in neurology where the neurological exam is paramount). Perhaps research power, money and esteem should be weightier considerations for fellowship or post-residency employment, and residency applicants should better sniff-out the pedagogical robustness of training institutions.

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