Associations Between Structural and Social Determinants of Health with Pediatric Surgical Site Infections

Determine if disparities exist in surgical site infections (SSI) for pediatric patients from minoritized language and racial and ethnic groups, and for those with a public insurance payor. Design, Setting, and Participants: This single-center cohort study retrospectively examined outcomes of patients undergoing eligible inpatient and outpatient surgical procedures from October 1, 2015 to September 30, 2020 at a freestanding children’s hospital and regional referral center; procedures without skin incisions were excluded. Methods: SSI cases were identified via an internally developed and validated surveillance algorithm. Models were constructed for each exposure: language of care, race and ethnicity, and insurance payor. Adjusted risk ratios were generated using log-binomial regression with clustering at the patient. All models were adjusted for patient and procedure factors known to affect SSI risk. Results: 39,508 patients contributed 52,529 eligible surgeries with 800 SSIs (1.52%). Language did not have an association with SSI (aRR for LOE group compared to English, 1.03, 95% CI 0.80-1.29, P=0.91); an association with higher SSI risk was seen for patients with race and ethnicity of America Indian and Alaska Native (aRR 1.47, 95% CI 1.01-2.15, P= 0.044) and those with Medicaid insurance (aRR 1.29, 95% CI 1.11-1.50, P= 0.001). Conclusions: We observed a similar SSI risk for patients using a language other than English but identified disparities with a higher SSI risk in those identifying as American Indian and Alaska Native and those with Medicaid insurance. Assessing for disparities through infection prevention work is essential so strategies can be optimized to better serve disproportionately impacted groups.