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Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment.

Publication ,  Journal Article
Jackson, SS; Leekha, S; Magder, LS; Pineles, L; Anderson, DJ; Trick, WE; Woeltje, KF; Kaye, KS; Lowe, TJ; Harris, AD
Published in: Clin Infect Dis
September 1, 2017

BACKGROUND: Healthcare-associated infections such as surgical site infections (SSIs) are used by the Centers for Medicare and Medicaid Services (CMS) as pay-for-performance metrics. Risk adjustment allows a fairer comparison of SSI rates across hospitals. Until 2016, Centers for Disease Control and Prevention (CDC) risk adjustment models for pay-for-performance SSI did not adjust for patient comorbidities. New 2016 CDC models only adjust for body mass index and diabetes. METHODS: We performed a multicenter retrospective cohort study of patients undergoing surgical procedures at 28 US hospitals. Demographic data and International Classification of Diseases, Ninth Revision codes were obtained on patients undergoing colectomy, hysterectomy, and knee and hip replacement procedures. Complex SSIs were identified by infection preventionists at each hospital using CDC criteria. Model performance was evaluated using measures of discrimination and calibration. Hospitals were ranked by SSI proportion and risk-adjusted standardized infection ratios (SIR) to assess the impact of comorbidity adjustment on public reporting. RESULTS: Of 45394 patients at 28 hospitals, 573 (1.3%) developed a complex SSI. A model containing procedure type, age, race, smoking, diabetes, liver disease, obesity, renal failure, and malnutrition showed good discrimination (C-statistic, 0.73) and calibration. When comparing hospital rankings by crude proportion to risk-adjusted ranks, 24 of 28 (86%) hospitals changed ranks, 16 (57%) changed by ≥2 ranks, and 4 (14%) changed by >10 ranks. CONCLUSIONS: We developed a well-performing risk adjustment model for SSI using electronically available comorbidities. Comorbidity-based risk adjustment should be strongly considered by the CDC and CMS to adequately compare SSI rates across hospitals.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

September 1, 2017

Volume

65

Issue

5

Start / End Page

803 / 810

Location

United States

Related Subject Headings

  • United States
  • Surgical Wound Infection
  • Risk Factors
  • Risk Adjustment
  • Retrospective Studies
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • Female
 

Citation

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Jackson, S. S., Leekha, S., Magder, L. S., Pineles, L., Anderson, D. J., Trick, W. E., … Harris, A. D. (2017). Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment. Clin Infect Dis, 65(5), 803–810. https://doi.org/10.1093/cid/cix431
Jackson, Sarah S., Surbhi Leekha, Laurence S. Magder, Lisa Pineles, Deverick J. Anderson, William E. Trick, Keith F. Woeltje, Keith S. Kaye, Timothy J. Lowe, and Anthony D. Harris. “Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment.Clin Infect Dis 65, no. 5 (September 1, 2017): 803–10. https://doi.org/10.1093/cid/cix431.
Jackson SS, Leekha S, Magder LS, Pineles L, Anderson DJ, Trick WE, et al. Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment. Clin Infect Dis. 2017 Sep 1;65(5):803–10.
Jackson, Sarah S., et al. “Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment.Clin Infect Dis, vol. 65, no. 5, Sept. 2017, pp. 803–10. Pubmed, doi:10.1093/cid/cix431.
Jackson SS, Leekha S, Magder LS, Pineles L, Anderson DJ, Trick WE, Woeltje KF, Kaye KS, Lowe TJ, Harris AD. Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment. Clin Infect Dis. 2017 Sep 1;65(5):803–810.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

September 1, 2017

Volume

65

Issue

5

Start / End Page

803 / 810

Location

United States

Related Subject Headings

  • United States
  • Surgical Wound Infection
  • Risk Factors
  • Risk Adjustment
  • Retrospective Studies
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • Female