Geographical outcome disparities in infection occurrence after colorectal surgery: An analysis of 58,096 colorectal surgical procedures

Abstract

Background: Despite improved surgical practices and in-hospital surveillance systems, surgical site infections remain a major public health problem worldwide and often require readmission to hospital. The aim was to apply an advance and innovative spatial analysis approach to identify spatial pattern and clustering (hotspots) of surgical site infection rate (CSIR), and quantifying disparities across communities.

Methods: We used the Admitted Patient Data Collection for patients aged 18 years and over who underwent colorectal surgery in a public hospital between 2002 and 2013 in the Australian State of New South Wales (NSW). The colorectal surgical infection rate (CSIR) was computed. We assessed geographical variation and clustering in CSIR patterning to demonstrate spatial pattern and clustering across communities in NSW, Australia.

Results: There were 58,096 colorectal surgical procedures conducted in NSW from 2002 to 2013. The overall occurrence of CSIR was 9.64% (95%CI 9.40-9.88%). We found significant clusters of both high and low CSIR in outer regional and remote areas of NSW.

Conclusion: Use of advanced spatial analyses allows identification of hotspots/clusters of adverse events that can help policy makers and clinicians better understand national patterns and initiate research to address disparities/geographical variation, and clustering of adverse events after surgery.

Keywords: Colorectal surgery; GIS; Inequality; Spatial analysis.