Academic Medical Centers Had Higher Rates of Postoperative Healthcare-associated Infections During the COVID-19 Pandemic

Brett Tracy; Carrie Valdez; Brandon Crowley; Sirivan Seng; Asanthi Ratnasekera; Bishwajit Bhattacharya; Rick O'Connor; Victoria Sharp; Rondi Gelbard

We sought to examine healthcare-associated infections (HAIs) among patients who underwent an appendectomy during the COVID-19 pandemic at academic medical centers (AMCs) and non-AMCs.

We hypothesized that AMCs would be associated with higher rates of HAI compared to non-AMCs.

We performed a prospective, observational, multicenter study of patients aged ≥ 18 years who underwent appendectomy for acute appendicitis before, during, and after the end of pandemic operative restrictions for the first COVID-19 peak. Patients were grouped according to hospital type (AMC vs non-AMC) and then classified as pre-pandemic (Pre-CoV: October 2019-January 2020), during the first 2020 pandemic peak (CoV: April 2020 through local end of pandemic restrictions), and Post-CoV (4 month period following the end of each site’s pandemic restrictions). Our primary outcome was the incidence ofpost-operative HAIs, which we compared between hospital types during each period. HAIs included surgical site infections, central-line–associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and Clostridioides difficile infections.

There were 1003 patients: 30.5% (n=306) were treated at non-AMCs and 69.5% (n=697) at AMCs.  For the entire cohort, 40 patents (3.9%) experienced an HAI.  More HAIs occurred at AMCs (4.9% vs 2%, p=0.03), which remained significant after stratifying by study period (3.6% Pre-CoV vs 7.7% CoV vs 3.7% Post-CoV, p=0.02). On multivariable regression controlling for age, white blood cell count, frailty, immunocompromised status, and the intraoperative detection of a gangrenous/perforated appendix, AMCs were an independent risk factor for HAIs (aOR 8.6, 95% CI 1.6-158.5, p<.01) during the CoV period.  However, during the pre- and post-CoV periods, AMCs were not a significant risk factor for HAIs.

Among patients who underwent an appendectomy, HAIs were significantly higher at AMCs, particularly during the initial 2020 pandemic peak.  These findings highlight the need for AMCs to be increasingly vigilant about infection control and prevention efforts as COVID-19 pandemic surges occur.