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Complex Surgical Site Infections and the Devilish Details of Risk Adjustment: Important Implications for Public Reporting

Published online by Cambridge University Press:  02 January 2015

Deverick J. Anderson ,
Luke F. Chen ,
Daniel J. Sexton  and
Keith S. Kaye
Deverick J. Anderson*
Affiliation:
Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Luke F. Chen
Affiliation:
Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Keith S. Kaye
Affiliation:
Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
*
Duke University Medical Center, Box 3605, Durham, NC 27710 (dja@duke.edu)
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Abstract

Objective.

To validate the National Nosocomial Infection Surveillance (NNIS) risk index as a tool to account for differences in case mix when reporting rates of complex surgical site infection (SSI).

Design.

Prospective cohort study.

Setting.

Twenty-four community hospitals in the southeastern United States.

Methods.

We identified surgical procedures performed between January 1, 2005, and June 30, 2007. The Goodman-Kruskal gamma or G statistic was used to determine the correlation between the NNIS risk index score and the rates of complex SSI (not including superficial incisional SSI). Procedure-specific analyses were performed for SSI after abdominal hysterectomy, cardiothoracic procedures, colon procedures, insertion of a hip prosthesis, insertion of a knee prosthesis, and vascular procedures.

Results.

A total of 2,257 SSIs were identified during the study period (overall rate, 1.19 SSIs per 100 procedures), of which 1,093 (48.4%) were complex (0.58 complex SSIs per 100 procedures). There were 45 complex SSIs identified following 7,032 abdominal hysterectomies (rate, 0.64 SSIs per 100 procedures); 63 following 5,318 cardiothoracic procedures (1.18 SSIs per 100 procedures); 139 following 5,144 colon procedures (2.70 SSIs per 100 procedures); 63 following 6,639 hip prosthesis insertions (0.94 SSIs per 100 procedures); 73 following 9,658 knee prosthesis insertions (0.76 SSIs per 100 procedures); and 55 following 6,575 vascular procedures (0.84 SSIs per 100 procedures). All 6 procedure-specific rates of complex SSI were significantly correlated with increasing NNIS risk index score (P< .05).

Conclusions.

Some experts recommend reporting rates of complex SSI to overcome the widely acknowledged detection bias associated with superficial incisional infection. Furthermore, it is necessary to compensate for case-mix differences in patient populations, to ensure that intrahospital comparisons are meaningful. Our results indicate that the NNIS risk index is a reasonable method for the risk stratification of complex SSIs for several commonly performed procedures.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 10 , October 2008 , pp. 941 - 946
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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