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Associations Between Surgical Site Infection Risk and Hospital Operation Volume and Surgeon Operation Volume Among Hospitals in the Dutch Nosocomial Infection Surveillance Network

Published online by Cambridge University Press:  02 January 2015

Jan Muilwijk ,
Susan van den Hof  and
Jan C. Wille
Jan Muilwijk*
Affiliation:
National Institute of Public Health and the Environment, Centre for Infectious Disease Epidemiology, Bilthoven, The Netherlands
Susan van den Hof
Affiliation:
National Institute of Public Health and the Environment, Centre for Infectious Disease Epidemiology, Bilthoven, The Netherlands KNCV Tuberculosis Foundation, The Hague, The Netherlands
Jan C. Wille
Affiliation:
Dutch Institute for Healthcare Improvement, Utrecht, The Netherlands
*
National Institute of Public Health and the Environment (PB 75), PO Box 1, 3720 BA, Bilthoven, The Netherlands ([email protected])
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Abstract

Objective.

To examine the association between hospital operation volume and surgeon operation volume and the risk of surgical site infection (SSI).

Design.

Prospective, multicenter cohort study based on surveillance data.

Methods.

Data were obtained from the Dutch surveillance network for nosocomial infections (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]) on 9 different types of orthopedic surgery, general surgery, and gynecology procedures performed during 1996-2003. Multilevel logistic regression analysis was performed to assess the independent effect of hospital volume and surgeon volume on SSI risk.

Results.

Hospital volume was not significantly associated with SSI risk for any of the selected procedures. Low surgeon volume was associated with an increased risk for an infection for 7 of 9 types of procedures, although this effect was statistically significant only for knee arthroplasty. For 4 procedures, the odds of exceeding the 75th percentile for duration of surgery were greater when the surgeon volume was low than when the surgeon volume was moderate or high.

Conclusions.

Patients operated on by surgeons with a low operation volume seem to have a higher risk of developing an SSI with some procedures, particularly knee arthroplasty. The higher SSI risk for surgeons with a low operation volume is possibly partly mediated by the longer duration of surgery, a well-known risk factor for development of SSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 5 , May 2007 , pp. 557 - 563
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Halm, EA, Lee, C, Chassin, MR. Is volume related to outcome in health care? A systematic review and methodologie critique of the literature. Ann Intern Med 2002;137:511–520.Google Scholar
2. Birkmeyer, JD, Stukel, TA, Siewers, AE, Goodney, PP, Wennberg, DE, Lucas, FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–2127.Google Scholar
3. Morgan, M, Black, J, Bone, F, et al. Clinician-led surgical site infection surveillance of orthopaedic procedures: a UK multicenter pilot study. J Hosp Infect 2005;60:201–212.Google Scholar
4. Katz, JN, Losina, E, Barrett, J, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am 2001;83:1622–1629.Google Scholar
5. Katz, JN, Barrett, J, Mahomed, NN, Baron, JA, Wright, RJ, Losina, E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 2004;86:1909–1916.Google Scholar
6. Geubbels, EL, Wille, JC, Nagelkerke, NJ, Vandenbroucke-Grauls, CM, Grobbee, DE, de Boer, AS. Hospital-related determinants for surgical-site infection following hip arthroplasty. Infect Control Hosp Epidemiol 2005;26:435–441.Google Scholar
7. Geubbels, EL, Mintjes-de Groot, AJ, van den Berg, JM, de Boer, AS. An operating surveillance system of surgical-site infections in The Netherlands: results of the PREZIES national surveillance network. Infect Control Hosp Epidemiol 2000;21:311–318.Google Scholar
8. PREZIES. Prevention of Nosocomial Infections by Surveillance: Handbook 2004 [ in Dutch]. Bilthoven/ Utrecht, The Netherlands: RIVM/CBO; 2004.Google Scholar
9. Dutch Working Party on Infection Prevention. Registration of Nosocomial Infections. Leiden, The Netherlands: Dutch Working Party on Infection Prevention; 2003.Google Scholar
10. Mannién, J, Wille, JC, Snoeren, RL, van den Hof, S. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands. Infect Control Hosp Epidemiol 2006;27:809–816.CrossRefGoogle Scholar
11. Solomon, DH, Losina, E, Baron, JA, et al. Contribution of hospital characteristics to the volume-outcome relationship: dislocation and infection following total hip replacement surgery. Arthritis Rheum 2002;46:2436–2444.Google Scholar
12. Shah, SN, Wainess, RM, Karunakar, MA. Hemiarthroplasty for femoral neck fracture in the elderly surgeon and hospital volume-related outcomes. J Arthroplasty 2005;20:503–508.Google Scholar
13. Hervey, SL, Purves, HR, Guller, U, Toth, AP, Vail, TP, Pietrobon, R. Provider volume of total knee arthroplasties and patient outcomes in the HCUP: nationwide inpatient sample. J Bone Joint Surg Am 2003;85:1775–1783.CrossRefGoogle ScholarPubMed
14. Muilwijk, J, Walenkamp, GH, Voss, A, Wille, JC, van den Hof, S. Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network ‘PREZIES’. J Hosp Infect 2006;62:319–326.Google Scholar
15. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999: Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.Google Scholar
16. Ihse, I. The volume-outcome relationship in cancer surgery: a hard sell. Ann Surg 2003;238:777–781.Google Scholar
17. Dagan, O, Birk, E, Katz, Y, Gelber, O, Vidne, B. Relationship between caseload and morbidity and mortality in pediatric cardiac surgery: a four year experience. Isr Med Assoc J 2003;5:471–474.Google Scholar
18. Farber, BF, Kaiser, DL, Wenzel, RP. Relation between surgical volume and incidence of postoperative wound infection. N Engl J Med 1981;305:200–204.Google Scholar