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A comparison of surgical site infections following total hip replacement and total knee replacement surgeries identified by Infection Prevention and Control and the National Surgical Quality Improvement Program in Alberta, Canada

Published online by Cambridge University Press:  24 May 2021

Jennifer J. R. Ellison Open the ORCID record for Jennifer J. R. Ellison [Opens in a new window] ,
Lesia R. Boychuk ,
David Chakravorty ,
A. Uma Chandran ,
John M. Conly ,
Andrea Howatt ,
Joseph Kim ,
Stacey Litvinchuk ,
Arun Pokhrel  and
Ye Shen
...Show all authors
Jennifer J. R. Ellison*
Affiliation:
Infection Prevention and Control, Alberta Health Services, Lethbridge, Alberta, Canada
Lesia R. Boychuk
Affiliation:
Infection Prevention and Control, Covenant Health, Edmonton, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
David Chakravorty
Affiliation:
Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
A. Uma Chandran
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Infection Prevention and Control, Alberta Health Services, Edmonton, Alberta, Canada
John M. Conly
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
Andrea Howatt
Affiliation:
Infection Prevention and Control, Covenant Health, Edmonton, Alberta, Canada
Joseph Kim
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
Stacey Litvinchuk
Affiliation:
Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
Arun Pokhrel
Affiliation:
System Performance and Innovation, EMS, Alberta Health Services, Calgary, Alberta, Canada
Ye Shen
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
Christopher Smith
Affiliation:
Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
Kathryn Bush
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
*
Author for correspondence: Jennifer J. R. Ellison, E-mail: [email protected]
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Abstract

Objective:

To understand how the different data collections methods of the Alberta Health Services Infection Prevention and Control Program (IPC) and the National Surgical Quality Improvement Program (NSQIP) are affecting reported rates of surgical site infections (SSIs) following total hip replacements (THRs) and total knee replacements (TKRs).

Design:

Retrospective cohort study.

Setting:

Four hospitals in Alberta, Canada.

Patients:

Those with THR or TKR surgeries between September 1, 2015, and March 31, 2018.

Methods:

Demographic information, complex SSIs reported by IPC and NSQIP were compared and then IPC and NSQIP data were matched with percent agreement and Cohen’s κ calculated. Statistical analysis was performed for age, gender and complex SSIs. A P value <.05 was considered significant.

Results:

In total, 7,549 IPC and 2,037 NSQIP patients were compared. The complex SSI rate for NSQIP was higher compared to IPC (THR: 1.19 vs 0.68 [P = .147]; TKR: 0.92 vs 0.80 [P = .682]). After matching, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC, and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.0; κ = 0.48).

Conclusions:

Different approaches to monitor SSIs may lead to different results and trending patterns. NSQIP reports total SSI rates that are consistently higher than IPC. If systems are compared at any point in time, confidence on the data may be eroded. Stakeholders need to be aware of these variations and education provided to facilitate an understanding of differences and a consistent approach to SSI surveillance monitoring over time.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 4 , April 2022 , pp. 435 - 441
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. Part of these data were presented as an abstract at the Sixth Decennial International Conference on Healthcare-Associated Infections, March 2020, held virtually (abstract published in ICHE 2020;41 suppl 1).

References

Won, SY, Wong, ES. Surgical site infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control, 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2012:286–306.Google Scholar
Surgical site infection: procedure-associated Module SSI. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published 2020. Accessed August 27, 2019.Google Scholar
Berríos-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784–791.CrossRefGoogle ScholarPubMed
Rennert-May, ED, Conly, J, Smith, S, et al. The cost of managing complex surgical site infections following primary hip and knee arthroplasty: a population-based cohort study in Alberta, Canada. Infect Control Hosp Epidemiol 2018;39:1183–1188.CrossRefGoogle ScholarPubMed
Infection Prevention and Control. Surgical site infections following total hip and total knee replacement (SSIs) provincial surveillance. https://www.albertahealthservices.ca/assets/healthinfo/ipc/hi-ipc-sr-hip-knee-ssi-protocol.pdf. Published 2019. Accessed August 27, 2019.Google Scholar
American College of Surgeons. ACS National Surgical Quality Improvement Program. https://www.facs.org/quality-programs/acs-nsqip. Accessed August 27, 2019.Google Scholar
Bordeianou, L, Cauley, CE, Antonelli, D, et al. Truth in reporting: how data capture methods obfuscate actual surgical site infection rates within a healthcare network system. Dis Colon Rectum 2017;60:96–106.CrossRefGoogle ScholarPubMed
Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilimoria, KY, Wick, EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015;150:51–57.CrossRefGoogle ScholarPubMed
Gase, KA, Kelly, L, Hohrein, M, Siebels, K, Babcock, HM. The National Healthcare Safety Network and the National Surgical Quality Improvement Program: discrepancies in reported surgical site infection rates. Am J Infect Control 2015;43:S16–S17.CrossRefGoogle Scholar
Childers, T, Usiak, SC, Sovel, M, et al. 909: Comparison of three different data sources for surgical site infection (SSI) surveillance after colon surgery. Open Forum Infect Dis 2014;1 suppl 1:S262–S262.CrossRefGoogle Scholar
Taylor, JS, Marten, CA, Potts, KA, et al. What is the real rate of surgical site infection? J Oncol Pract 2016;12:e878–e883.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network (NHSN) patient safety component manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/validation/2018/pcsmanual_2018-508.pdf. Published 2019. Accessed November 29, 2019.Google Scholar
Rusk, A, Bush, K, Brandt, M, et al. Improving surveillance for surgical site infections following total hip and knee arthroplasty using diagnosis and procedure codes in a provincial surveillance network. Infect Control Hosp Epidemiol 2016;37:699–703.CrossRefGoogle Scholar
Khuri, SF. The NSQIP: a new frontier in surgery. Surgery 2005;138:837–843.CrossRefGoogle ScholarPubMed
Shiloach, M, Frencher, SK, Steeger, JE, et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010;210:6–16.CrossRefGoogle ScholarPubMed
McHugh, ML. Interrater reliability: the kappa statistic. Biochem Med 2012;22:276–282.CrossRefGoogle ScholarPubMed
CIHI information quality framework. Canadian Institute for Health Information website. https://www.cihi.ca/sites/default/files/document/iqf-summary-july-26-2017-en-web_0.pdf. Published 2017. Accessed April 19, 2021.Google Scholar
Bohl, DD, Basques, BA, Golinvaux, NS, Baumgaertner, MR, Grauer, JN. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies. Clin Orthop Relat Res 2014;472:1672–1680.CrossRefGoogle ScholarPubMed
Bedard, NA, Pugely, AJ, McHugh, M, et al. Analysis of outcomes after TKA: do all databases produce similar findings? Clin Orthop Relat Res 2018;476:52–63.CrossRefGoogle ScholarPubMed
Pierce, AZ, Menendez, ME, Tybor, DJ, Salzler, MJ. Three different databases, three different complication rates for knee and hip arthroplasty: comparing the National Inpatient Sample, National Hospital Discharge Survey, and National Surgical Quality Improvement Program, 2006 to 2010. J Am Acad Orthop Surg 2019;27:e568–e576.CrossRefGoogle ScholarPubMed
Aiello, FA, Shue, B, Kini, N, et al. Outcomes reported by the Vascular Quality Initiative and the National Surgical Quality Improvement Program are not comparable. J Vasc Surg 2014;60:152–159.CrossRefGoogle Scholar
Ali-Mucheru, MN, Seville, MT, Miller, V, Sampathkumar, P, Etzioni, DA. Postoperative surgical site infections: understanding the discordance between surveillance systems. Ann Surg 2020;271:94–99.CrossRefGoogle ScholarPubMed
Etzioni, DA, Lessow, CL, Lucas, HD, et al. Infectious surgical complications are not dichotomous: characterizing discordance between administrative data and registry data. Ann Surg 2018;267:81–87.CrossRefGoogle Scholar
Ming, DY, Chen, LF, Miller, BA, Sexton, DJ, Anderson, DJ. The impact of depth of infection and postdischarge surveillance on rate of surgical-site infections in a network of community hospitals. Infect Control Hosp Epidemiol 2012;33:276–282.CrossRefGoogle Scholar
Bohl, DD, Russo, GS, Basques, BA, et al. Variations in data collection methods between national databases affect study results: a comparison of the Nationwide Inpatient Sample and National Surgical Quality Improvement Program databases for lumbar spine fusion procedures. J Bone Jt Surg 2014;96(23):e193.CrossRefGoogle ScholarPubMed
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