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BACKGROUND:
Post-operative surgical site infections (SSI) are a source of potentially preventable peri-operative morbidity. Numerous studies have investigated the prevalence of SSI following adult urologic operations. However, there is a staggering paucity of data regarding the expected baseline rate of SSI in pediatric patients undergoing urologic procedures. This study evaluates the rate and type of surgical site infections in a cohort of prospective patients undergoing genitourinary procedures.
METHODS:
A prospective quality assurance database on 30 day SSI was maintained for consecutive patients undergoing open (non-endoscopic) pediatric urologic surgical procedures performed by three pediatric urologists. IRB-approval was obtained to review this database of all pediatric genitourinary (GU) procedures performed between August, 2011 and April, 2014. The primary outcome was the incidence of SSI. Patients were included only if they returned for a follow-up visit after their surgical procedure. SSI were broken down by superficial skin (SS), deep/organ site (D/OS) and urinary tract infection (UTI) according to CDC guidelines. SSI were confirmed by a pediatrician or the surgeon and required antibiotic therapy.
The rate of SSI infection reported is site and wound class (WC) specific as a number of patients had multiple site procedures. Only patients with wound class (WC) 1 (clean) and 2 (clean-contaminated) were included in the analysis. Specific surgical sites included: 1) primary penile procedures; 2) inguinal procedures; 3) scrotal procedures; 4) abdominal procedures (including flank and laparoscopic) and 5) female genitalia procedures. A relative risk and chi-squared analysis was performed to determine statistical significance comparing WC1 and WC2 procedures.
RESULTS:
1185 unique patients with 1313 surgical sites were available for review during the time period between August 2011 and April 2014. Of these, 1020 patients with 1133 surgical sites had adequate follow up for inclusion into the study. 10 total SSI infections were reported during the follow-up period. The overall rate of SSI in pediatric urologic procedures was 0.9%. There were 6 SS infections, 1 D/OS infection and 3 UTI. Site specific SSI occurrences and rates are shown in Table 1.
773 WC1 surgical sites had 3 SS infections, for a SS infection rate of 0.4%. 360 WC2 surgical sites had 3 SS infections (0.8%), 1 deep infection (0.3%), and 3 UTI (0.8%). The overall rate of SSI in WC2 infections (1.9%) compared to WC 1 infections (0.4%) demonstrated statistical significance with a p-value <0.01. The relative risk of any SSI when the surgical procedure violates the genitourinary tract, thus upgrading the wound class from WC1 to WC2, is 5.0.
CONCLUSIONS:
Overall rates of surgical site infection in children undergoing genitourinary surgical procedures are low. Violating the urinary tract, as in WC 2 procedures, is associated with a statistically significant increase in SSI and a 5 fold increase in relative risk of an SSI.

TABLE 1: SURGICAL SITE SPECIFIC INFECTIONS
Surgical Site	Wound Class	Unique Procedures	Total # of Infections (%)	SS Infections (%)	D/OS Infections (%)	UTI (%)
Overall	Combined	1133	10 (0.9%)	6 (0.5%)	1 (0.1%)	3 (0.3%)
Penis	Combined	705	6 (0.8%)	5 (0.7%)	0	1 (0.1%)
	1	471	2 (0.4%)	2 (0.4%)	0	0
	2	234	4 (1.7%)	3 (1.3%)	0	1 (0.4%)
Abdominal	Combined	232	3 (1.3%)	0	1 (0.4%)	2 (0.9%)
	1	159	0	0	0	0
	2	73	3 (4.3%)	0	1 (1.4%)	2 (2.7%)
Inguinal	1	101	0	0	0	0
Scrotal	1	154	1 (0.6%)	1 (0.6%)	0	0
Female Genitalia	Combined	17	0	0	0	0