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Low post-surgical infection risk at Children's Hospital

This article first appeared in the St. Louis Beacon, Aug. 28, 2011 - The risk of infections following surgery at St. Louis Children's Hospital is far lower than the national average, but the rate among black children treated at the hospital is twice that of whites, according to a study by doctors at Washington University Medical School.

Infections after surgery were less than 1 percent for all patients at Children's, according to the researchers, Dr. Martin Keller, a pediatric surgeon; and Dr. Brian Bucher, a surgery resident at the medical school. For African Americans treated at Children's, the surgical site infection rate was about 2 percent, the researchers found. The findings were reported in the Journal of the American College of Surgeons.

While there was a gap between black-white infection rates following surgery at Children's, Keller said the problem among black children here didn't appear to be as pronounced as it was nationally.

"There are disparate results," he said. "But they are still less than the reported standards throughout the country. Most of the literature have published rates of about 2 to 3 percent for these types of procedures nationwide. So even in our high risk groups involving African-American children, we're still below national averages."

Keller says too many variables come into play to offer easy explanations for the disparity.

"When talking about race and outcomes, it's very difficult to distinguish whether that's actually a fact of biology or a complication of a person's socio-economic status," he says.

He adds that information collected as part of a new national surgical quality improvement program among 30 pediatric hospitals, including Children's, will give researchers a large enough database to study the disparity issue more thoroughly. The study could help researchers make valid comparisons on a range of topics, including infections, disparities and other health issues involving children.

For example, Bucher noted, making simple comparisons between children's hospitals in general can be misleading because of differences in the types of patients served by different hospitals.

"Hospitals that take care of sicker patients are going to have higher complication rates," he says. "It's always a problem when you compare two hospitals because they are not exactly alike."

The researchers suggested that the infection rates at Children's may be lower in relation to the national average because the hospital happens to be one of the few nationwide with a special unit devoted to treating wounds, including surgical site infections.

Though unrelated, this study comes as the federal government is paying more attention to certain types of hospital acquired infections. Beginning this year, for example, hospitals were required to report the rates of certain types of infections and of readmissions. In future years, reimbursements will be tied to those rates.

Medical procedures examined in the Children's study involved orthopedic, plastic and general surgery, including operations involving the face, joints, lungs, chest, esophagus and stomach. The researchers found that children facing the highest risk of infection were those admitted to the intensive care unit following surgery. Children who were admitted to the hospital after surgery, rather than discharged to home, also faced a higher risk of infection, the researchers said.

The doctors' study was based on a review of medical records of about 16,000 patients who underwent surgery at Children's between 1996 and 2008. The study found that 159 of the children developed infections. Fifty of the 159 infections involved African-American patients. Although not very high, the number of infections at Children's has a big impact on affected children and families, Keller says.

"The infection rate is very, very low, but even a small percentage of infections can lead to a significant number of hospitalizations for wound problems as well as the impact (the infections have) on the family for home care and days of work lost in a family to care for the child."

In addition, Bucher says that many children who return to the hospital for treatment of a surgical site infection end up being admitted. The researchers noted that pediatric patients with surgical site infections remained in the hospital an average of 13 days, compared to eight days for children without such infections. These longer hospital stays add to health care cost. That's among reasons behind federal efforts to persuade hospitals to do more to prevent infections.

The researchers also called attention to more reports of antibiotic-resistance bacteria in surgical site infections among children in the study. They said this finding mirrored national trends.

"The bacteria out there tends to be smarter than us and ahead of the game to some extent," Keller said. "We're finding a much higher rate of resistant organisms than what was reported in the past. I think this speaks to the values of studies like this and why they should be repeated periodically."

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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