Dual Surveillance of Surgical Site Infections Using CDC and ASEPSIS Criteria: Clinical and Economic Outcomes in Colorectal and Small Bowel Surgery

Abstract

Background: Surgical site infection (SSI) adversely affects postoperative outcomes and resource utilization. CDC-based definitions may under-identify minor yet clinically significant wound healing disturbances. This study evaluated the incidence and burden of SSIs using both the CDC criteria and the ASEPSIS scoring system. Methods: A prospective observational study was conducted at a tertiary referral center between August 2018 and January 2019. Patients undergoing colorectal or small bowel surgery were monitored for SSIs using CDC criteria and ASEPSIS scores. Surgical wounds were assessed on postoperative days 2, 4, and 6 with follow-up until 30 days. SSI was defined as either meeting the CDC criteria or having an ASEPSIS score > 21. ASEPSIS scores of 10–19 were classified as wound disturbance. Results: Among 460 patients, 54 (11.7%) developed SSIs: 53 based on CDC criteria and 15 based on ASEPSIS score. When ASEPSIS scores of 10–19 were included, the wound complication rate increased to 17.6%. Patients with SSIs had longer hospital stays (15.6 ± 8.0 vs. 11.0 ± 5.5 days, p < 0.001) and incurred 36% higher total hospital costs. Among patients with ASEPSIS scores of 10–19 but no CDC-defined SSI (n = 28), hospital stay and inpatient costs were comparable to those of SSI-free patients. However, outpatient visits (6.5 ± 9.3 vs. 1.1 ± 1.3, p = 0.005) and costs (USD 99 ± 91 vs. USD 48 ± 48, p = 0.007) were significantly higher. Conclusions: The ASEPSIS scoring system identified clinically relevant wound disturbances that were not detected by CDC criteria. Dual surveillance revealed additional postoperative morbidity and outpatient burden. Integrating ASEPSIS into routine monitoring may improve wound complication detection and enable earlier interventions.