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The Seasonal Variability in Surgical Site Infections and the Association With Warmer Weather: A Population-Based Investigation

Published online by Cambridge University Press:  16 May 2017

Chris A. Anthony ,
Ryan A. Peterson ,
Linnea A. Polgreen ,
Daniel K. Sewell  and
Philip M. Polgreen
Chris A. Anthony
Affiliation:
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Ryan A. Peterson
Affiliation:
Department of Biostatistics, University of Iowa, Iowa City, Iowa
Linnea A. Polgreen
Affiliation:
Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa
Daniel K. Sewell
Affiliation:
Department of Biostatistics, University of Iowa, Iowa City, Iowa
Philip M. Polgreen*
Affiliation:
Departments of Internal Medicine and Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa University of Iowa Health Ventures’ Signal Center for Health Innovation, Iowa City, Iowa
*
Address correspondence to Philip M. Polgreen, MD, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 (philip-polgreen@uiowa.edu).
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Abstract

OBJECTIVE

To determine whether the seasonality of surgical site infections (SSIs) can be explained by changes in temperature.

DESIGN

Retrospective cohort analysis.

SETTING

The National Inpatient Sample database.

PATIENTS

All hospital discharges with a primary diagnosis of SSI from 1998 to 2011 were considered cases. Discharges with a primary or secondary diagnoses of specific surgeries commonly associated with SSIs from the previous and current month served as our “at risk” cohort.

METHODS

We modeled the national monthly count of SSI cases both nationally and stratified by region, sex, age, and type of institution. We used data from the National Climatic Data Center to estimate the monthly average temperatures for all hospital locations. We modeled the odds of having a primary diagnosis of SSI as a function of demographics, payer, location, patient severity, admission month, year, and the average temperature in the month of admission.

RESULTS

SSI incidence is highly seasonal, with the highest SSI incidence in August and the lowest in January. During the study period, there were 26.5% more cases in August than in January (95% CI, 23.3–29.7). Controlling for demographic and hospital-level characteristics, the odds of a primary SSI admission increased by roughly 2.1% per 2.8°C (5°F) increase in the average monthly temperature. Specifically, the highest temperature group, >32.2°C (>90°F), was associated with an increase in the odds of an SSI admission of 28.9% (95% CI, 20.2–38.3) compared to temperatures <4.4°C (<40°F).

CONCLUSIONS

At population level, SSI risk is highly seasonal and is associated with warmer weather.

Infect Control Hosp Epidemiol 2017;38:809–816

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 809 - 816
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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