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Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting.

Publication ,  Journal Article
Anderson, DJ; Chen, LF; Sexton, DJ; Kaye, KS
Published in: Infect Control Hosp Epidemiol
October 2008

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.

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Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

October 2008

Volume

29

Issue

10

Start / End Page

941 / 946

Location

United States

Related Subject Headings

  • United States
  • Surgical Wound Infection
  • Surgical Procedures, Operative
  • Risk Factors
  • Risk Adjustment
  • Population Surveillance
  • Mandatory Reporting
  • Humans
  • Hospitals, Community
  • Epidemiology
 

Citation

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Anderson, D. J., Chen, L. F., Sexton, D. J., & Kaye, K. S. (2008). Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hosp Epidemiol, 29(10), 941–946. https://doi.org/10.1086/591457
Anderson, Deverick J., Luke F. Chen, Daniel J. Sexton, and Keith S. Kaye. “Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting.Infect Control Hosp Epidemiol 29, no. 10 (October 2008): 941–46. https://doi.org/10.1086/591457.
Anderson DJ, Chen LF, Sexton DJ, Kaye KS. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hosp Epidemiol. 2008 Oct;29(10):941–6.
Anderson, Deverick J., et al. “Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting.Infect Control Hosp Epidemiol, vol. 29, no. 10, Oct. 2008, pp. 941–46. Pubmed, doi:10.1086/591457.
Anderson DJ, Chen LF, Sexton DJ, Kaye KS. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hosp Epidemiol. 2008 Oct;29(10):941–946.
Journal cover image

Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

October 2008

Volume

29

Issue

10

Start / End Page

941 / 946

Location

United States

Related Subject Headings

  • United States
  • Surgical Wound Infection
  • Surgical Procedures, Operative
  • Risk Factors
  • Risk Adjustment
  • Population Surveillance
  • Mandatory Reporting
  • Humans
  • Hospitals, Community
  • Epidemiology