Postdischarge surveillance: The impact on surgical site infection incidence in a Brazilian university hospital

Objective: This prospective cohort study was carried out in a surgical unit of a university hospital in Brazil. The purpose of the study was to determine the incidence of surgical site infection (SSI) in patients during hospitalization and after discharge from the hospital. Method: In a sample of 630 patients who underwent surgical procedures, association among diagnosis of SSI (in-hospital or postdischarge), class of the surgery (elective or emergency), hospitalization period, patient's clinical condition (American Society of Anesthesiologists [ASA] score), classification of surgical site, and duration of surgical procedure were verified. Results: Fifty SSIs were diagnosed while the patients were still in the hospital, and 140 postdischarge. Hospitalization periods >5 days and worse clinical condition (ASA III) were associated with a higher SSI incidence. Classification of SSI was not correlated to the incidence of in-hospital SSI, except for clean surgeries. Surgical procedures of >5 hours duration were correlated to SSI during hospitalization, and procedures of >2 hours duration correlated to a postdischarge SSI. Most SSIs (73.7%) were diagnosed postdischarge. Conclusion: Results show a high incidence of postsurgical infection detected during postdischarge surveillance, which suggests the need for postdischarge follow-ups for surgical patients.