Pediatric Surgical Site Infections and Language

PEDIATRIC surgical site infections were linked to language differences and substantially greater hospitalization and readmission burdens.

Researchers examining gastrointestinal surgery in children found that those who developed an infection were more likely to speak a primary language other than English or Spanish. The findings also questioned whether infection models built around adult risk factors adequately reflect the needs of pediatric populations.

Language Linked to Pediatric Surgical Site Infections

The case control study included 246 patients from birth to 21 years of age who underwent gastrointestinal surgery between 2019 and 2022 at a tertiary pediatric referral center. Procedures included appendix, gastric, small bowel, colon, and exploratory laparotomy operations.

Investigators compared 82 patients who developed pediatric surgical site infections within 30 days of surgery with 164 matched controls. Participants were matched according to age, prematurity, procedure category, and surgical year.

After adjustment, speaking a primary language other than English or Spanish was the only factor significantly associated with infection. These patients had more than four times the adjusted odds of developing an infection compared with the control group, with an adjusted odds ratio of 4.26.

The language category included Mandarin, Cantonese, Farsi, Arabic, Mixteco Alto, Mixteco Bajo, and Triqui Bajo. Spanish language was not associated with increased infection odds.

Infections Increase Postoperative Care Burden

Pediatric surgical site infections were also associated with substantially poorer postoperative outcomes. Children who developed an infection had a median hospital stay of 17.5 days, compared with 7 days among controls.

Thirty day readmission rates were also higher in the infection group, at 26%, compared with 10% among children who did not develop an infection.

Rates of antibiotic prophylaxis, preoperative bathing, skin preparation, and other assessed infection prevention measures were broadly comparable between the two groups.

Adult Risk Models May Miss Pediatric Factors

Common variables used in adult standardized infection ratio models, including diabetes, obesity, and American Society of Anesthesiologists physical status scores, were not significant predictors of pediatric surgical site infections.

The researchers cautioned that the single center, retrospective design and relatively small sample prevented conclusions about causality. Use of interpreter services during individual encounters could not be evaluated, and the broad language category may have obscured differences between communities.

Nevertheless, the results emphasize the potential importance of language-concordant perioperative communication and multilingual support. The findings also support developing pediatric-specific infection measures that incorporate social and demographic factors rather than relying exclusively on adult-derived models.

Reference
Khoury V et al. Pediatric gastrointestinal surgical site infections: a case-control study. Infect Control Hosp Epidemiol. 2026;DOI:10.1017/ice.2026.10502.

Featured Image: Monkey Business on Adobe Stock.