Introduction: The development of infectious complications after high volume elective surgical procedures imposes a significant clinical burden to the United States population. This study evaluated the association of delay of elective procedures and the subsequent impact on infectious complications after coronary artery bypass graft (CABG) surgery, colon resection, and lung resection. Infectious complications evaluated included pneumonia (PNA), urinary tract infections (UTI), postoperative sepsis, and surgical site infections (SSI).

Methods: The Nationwide Inpatient Sample was queried between 2003-2007 and patients that developed postoperative infectious complications were identified. Time to elective surgery in days from admission was calculated and the following delayed groups were created: 0, 1 day, 2-5 days, and 6-10 days. Patients with a surgery delay of more than 10 days (less than 1% of all cases) were excluded. Chi square, multivariable logistic regression analyses, and Cochran-Armitage trend test were utilized.

Results: 87,318 CABG procedures, 46,728 colon resections, and 28,960 lung resections were evaluated (non-weighted values). Total infection rates significantly increased after elective surgery delays: CABG: 0=5.73%;1=6.68%;2-5=9.33%;6-10=18.24%; Colon Resections:0=8.43%;1=11.86%;2-5=15.79%;6-10= 21.62%; and Lung Resections: 0=10.17%;1=14.53%;2-5=15.53%;6-10=20.56%, p<.0001 for all trends. Trends for increasing infections after delay were significant for PNA and sepsis for all procedures (P<0.0001); UTI and SSI significantly increased after CABG and colon resection. Adjusted by age, gender, race, and comorbidities, the odds ratios of developing postoperative infection by delay from admission were calculated (graph below). Mean cost increased after all procedures with delays: CABG: $36,079 vs. $47,527 (p<.0001), Colon Resections: $20,265 vs. $29,887 (p<.0001), and Lung Resections: $26,323 vs. $30,571 (p=0.0032).

Conclusions: Delay of elective surgery from the day of admission was associated with a significant increase in infectious complications. This delay was also associated with a significant increase in hospital cost and utilization. Future policy directed toward preventing delay of elective surgery could offer significant cost savings and decrease infectious complications after elective surgery.
Adjusted odds ratios of Developing Postoperative Infection by Delay from Admission. Error bar = 95% confidence interval.