Over a recent 11-year period, the incidence of healthcare-associated infection (HAI) following major cancer surgery increased while deaths from these infections decreased, according to a nationwide survey.1

Each year, as many as 1.7 million patients in the United States develop HAI and, as a result, 99,000 die. Patients with cancer undergoing surgery represent a significant proportion of the hospitalized population, but they have been excluded from many epidemiological studies of HAI because of their high risk for infection. To determine the incidence and outcomes of HAI in this group, researchers led by Jesse Sammon, DO, of the Henry Ford Health System in Detroit, MI analyzed data from 1999 to 2009 from the Nationwide Inpatient Sample, a set of hospital inpatient databases that includes discharge information from 8 million hospital stays.

The investigators examined data from 2.5 million patients with cancer who underwent one of eight common major surgeries: colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, pneumonectomy, pancreatectomy, and prostatectomy.

During the entire study period, 10.5% of patients with cancer undergoing surgery developed one or more HAIs; this rate was more than three times higher than that previously reported for patients undergoing elective surgery. The incidences of urinary tract infection (UTI), surgical site infection (SSI), ventilator-associated pneumonia (VAP), and blood stream infection (BSI) were 4.2%, 3.2%, 3.5%, and 1.9%, respectively, in the patients with cancer.1

Temporal trend analysis found that the incidence of HAI in postsurgical patients with cancer increased by 2.7% per year, from 10% in 1999 to 11.4% in 2009. The incidence of BSI increased at the fastest rate, 3.9% per year, and that of VAP at the slowest rate, 1.3% per year.

At the same time, mortality among patients with HAI after major cancer surgery decreased by 1.3% per year, from 12.3% in 1999 to 9.9% in 2009. The incidences of all four infections decreased at similar rates. Nevertheless, patients who developed an HAI after major cancer surgery were 8.7 times more likely to die than patients who did not. There was a particularly higher risk of death among patients who developed BSI; these patients were 17.3 times more likely to die in the postoperative period than patients who were free of infection.

The study uncovered disturbing racial and socioeconomic disparities in the risk of infection: black patients were 26% more likely than patients of other races to develop an HAI, and patients with non-private insurance or no insurance were 18% to 67% more likely to do so.

The study authors suggest that patients who either have no insurance or are covered by public insurance lack adequate access to healthcare and present at a more advanced stage of illness, when management is more complex and more likely to result in infection. In addition, such patients are less likely to be treated at hospitals where infection control measures are well implemented.

After the publication in 1999 of the Institute of Medicine’s report, To Err Is Human,2 attention was focused on the issue of HAI and infection-control programs became more common. The researchers from Henry Ford Health System suggest that these innovations may have contributed to the decrease in the mortality rate from HAI, but urge that racial and socioeconomic disparities in access to care should be addressed.


References

1. Sammon J, Trinh VQ, Ravi L, et al. Health care-associated infections after major cancer surgery. Temporal trends, patterns of care, and effect on mortality. Cancer. 2013; Mar 19 [epub ahead of print].

2. Kohn LT, Corrigan JM, Donaldson MS (eds). To Err Is Human. Building a Safer Health System. Front Health Serv Manage. 2001 Fall;18(1):1-2.