Patients undergoing gastrointestinal surgery at safety net hospitals are at increased risk of surgical-site infections (SSIs), according to a research letter yesterday in JAMA Surgery.
Using data from the Nationwide Readmissions Database for, researchers from Memorial Regions Hospital in Florida assessed SSIs identified during initial admission or readmission within 90 days of gastrointestinal surgery from 2019 to 2020. Safety net hospitals were identified as publicly funded, metropolitan teaching, and large by number of beds per US region. To account for risk factors such as age, comorbidities, low household income, and lack of insurance, the researchers performed a propensity score matching analysis.
30% increased risk in safety net hospitals
Of the 392,368 patients identified, 23,447 (6.0%) were treated at safety net hospitals (mean age 52.4 years, 50.2% female). The overall SSI rate was 3.0%, of which 59.2% of infections were found during readmission, but the rate in safety net hospitals was 7.8%.
After propensity score matching, the overall SSI rate was 3.5%, and SSI risk was increased by nearly 30% in safety net hospitals (odds ratio, 1.29; 95% confidence interval, 1.16 to 1.42). SSI risk was higher at safety net hospitals for all sites (eg, superficial incisional, deep incisional, organ space).
The findings are noteworthy because the Centers for Medicare and Medicaid Services (CMS) has imposed financial penalties on hospitals that have high rates of healthcare-associated infections since 2014, and those penalties to date have proven ineffective at reducing infection rates at safety net hospitals. Although CMS made adjustments to hospital penalties for readmissions in 2019 to account for the socioeconomic differences among patients treated at safety net hospitals, the study authors say their findings indicate similar adjustments are needed for SSIs.