Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-28T15:33:54.988Z Has data issue: false hasContentIssue false
  • English
  • Français

Interhospital Comparison of Surgical Site Infection Rates in Orthopedic Surgery

Published online by Cambridge University Press:  31 January 2017

Jozica Skufca ,
Jukka Ollgren ,
Mikko J. Virtanen ,
Kaisa Huotari  and
Outi Lyytikäinen
Jozica Skufca*
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
Jukka Ollgren
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
Mikko J. Virtanen
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
Kaisa Huotari
Affiliation:
Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Outi Lyytikäinen
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
*
Address correspondence to Jozica Skufca, DVM, National Institute for Health and Welfare (THL), Mannerheimintie 166, PO Box 30, FI-00271 Helsinki, Finland ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To investigate whether comparison by deep or adjusted deep surgical site infection (SSI) rates in orthopedic surgeries are a better basis for feedback to Finnish hospitals than overall SSI rates

DESIGN

Retrospective cohort study

SETTING

Hospitals conducting surveillance of hip arthroplasties (HPROs) and knee arthroplasties (KPROs) in the Finnish Hospital Infection Program

METHODS

We analyzed surveillance data for 73,227 HPROs and 56,860 KPROs performed in 18 hospitals during 1999–2014. For each hospital, the overall, deep, and adjusted deep SSI rates with 95% confidence intervals (CIs) were calculated, and the hospital ranks were simulated in the Bayesian framework. Adjustments were performed using relevant patient and hospital characteristics. The correlation between the median expected hospital ranks in overall versus deep SSI rates and deep vs adjusted deep SSI rates were assessed using Spearman’s correlation coefficient ρ.

RESULTS

For HPRO, the overall SSI rates ranged from 0.92 to 6.83, the deep SSI rates ranged from 0.34 to 1.86, and the adjusted deep hospital-specific SSI rates ranged from 0.37 to 1.85. For KPRO, the overall SSI rates ranged from 0.71 to 5.03, the deep SSI rates ranged from 0.42 to 1.60, and the adjusted deep hospital-specific SSI rates ranged from 0.56 to 1.55. For both procedures, the 95% CIs of the rates between hospitals largely overlapped; only single outliers were detected. Hospital rank did not correlate between overall and deep SSI rates (HPRO, ρ=0.03; KPRO, ρ=0.40), but a correlation was observed in hospital rank for deep and adjusted deep SSI rates (HPRO, ρ=0.85; KPRO, ρ=0.94).

CONCLUSION

Deep SSI rates may be a better tool for interhospital comparisons than overall SSI rates. Although the adjustment could lead to fairer hospital ranking, it is not always necessary for feedback.

Infect Control Hosp Epidemiol 2017;38:423–429

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 4 , April 2017 , pp. 423 - 429
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: The data from this study were presented in part as a poster presentation at the 2016 European Scientific Conference on Applied Infectious Disease Epidemiology, Stockholm, Sweden, on November 28, 2016.

References

REFERENCES

1. Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183–189.CrossRefGoogle Scholar
2. Partanen, J, Syrjala, H, Vahanikkila, H, Jalovaara, P. Impact of deep infection after hip fracture surgery on function and mortality. J Hosp Infect 2006;62:44–49.CrossRefGoogle ScholarPubMed
3. Brandt, C, Sohr, D, Behnke, M, Daschner, F, Ruden, H, Gastmeier, P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006;27:1347–1351.CrossRefGoogle ScholarPubMed
4. Geubbels, EL, Nagelkerke, NJ, Mintjes-De Groot, AJ, et al. Reduced risk of surgical site infections through surveillance in a network. Int J Qual Health Care 2006;18:127–133.CrossRefGoogle ScholarPubMed
5. Jamtvedt, G, Young, JM, Kristoffersen, DT, O’Brien, MA, Oxman, AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Syst Rev 2006;2:CD000259.Google Scholar
6. Haley, RW. The scientific basis for using surveillance and risk factor data to reduce nosocomial infection rates. J Hosp Infect 1995;30:S3–S14.CrossRefGoogle ScholarPubMed
7. Løwer, HL, Eriksen, HM, Aavitsland, P, Skjeldestad, FE. Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: the value of a mandatory system, automated data collection, and active postdischarge surveillance. Am J Infect Control 2013;41:591–596.CrossRefGoogle ScholarPubMed
8. Brummer, S, Brandt, C, Sohr, D, Gastmeier, P. Does stratifying surgical site infection rates by the National Nosocomial Infection Surveillance risk index influence the rank order of the hospitals in a surveillance system? J Hosp Infect 2008;69:295–300.CrossRefGoogle ScholarPubMed
9. Sax, H, Pittet, D. Interhospital differences in nosocomial infection rates: importance of case-mix adjustment. Arch Intern Med 2002;162:2437–2442.CrossRefGoogle ScholarPubMed
10. Centers for Disease Control and Prevention. Nosocomial infection rates for interhospital comparison: limitations and possible solutions—a report from the National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 1991;12:609–621.CrossRefGoogle Scholar
11. Huotari, K. Surveillance of surgical site infections following major hip and knee surgery in Finland. Academic Dissertation. Publications of the National Public Health Institute. Helsinki; 2007.Google Scholar
12. Martin, M, Zingg, W, Hansen, S, Gastmeier, P, Wu, AW, Pittet, D, Dettenkofer, M, on behalf of the PROHIBIT study group. Public reporting of healthcare-associated infection data in Europe. What are the views of infection prevention opinion leaders? J Hosp Infect 2013;83:94.CrossRefGoogle ScholarPubMed
13. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
14. Huotari, K, Lyytikäinen, O, and the Hospital Infection Surveillance Team. Impact of postdischarge surveillance on the rate of surgical site infection after orthopaedic surgery. Infect Control Hosp Epidemiol 2006;27:1324.CrossRefGoogle Scholar
15. Spiegelhalter, DJ. Funnel plots for comparing institutional performance. Stat Med 2005;24:1185–1202.CrossRefGoogle ScholarPubMed
16. Austin, PC. A comparison of Bayesian methods for profiling hospital performance. Med Decis Making 2002;22:163–172.CrossRefGoogle ScholarPubMed
17. Normand, SLT, Glickrnan, ME, Gatsonis, CA. Statistical methods for profiling providers of medical care: issues and applications. J Am Statistic Assoc 1997;92:803–814.CrossRefGoogle Scholar
18. Hosmer, DW, Lemeshow, S, Sturdivant, RX. Applied Logistic Regression. 3rd ed. NewYork: John Wiley; 2013. p. 139.CrossRefGoogle Scholar
19. Goldstein, H, Spiegelhalter, DJ. League tables and their limitations: statistical issues in comparisons of institutional performance. J Roy Statistic Soc Series A 1996;159:385–443.CrossRefGoogle Scholar
20. Koek, MB, Wille, JC, Isken, MR, Voss, A, van Benthem, BH. Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill 2015;20 pii=21042.Google ScholarPubMed
21. Yokoe, DS, Avery, TR, Platt, R, Huang, SS. Reporting surgical site infections following total hip and knee arthroplasty: impact of limiting surveillance to the operative hospital. Clin Infect Dis 2013;57:1282–1288.CrossRefGoogle Scholar
22. Surveillance of surgical site infections in Europe 2010–2011. European Centre for Disease Prevention and Control website. http://ecdc.europa.eu/en/publications/Publications/SSI-in-europe-2010-2011.pdf. Published 2013. Accessed December 29, 2016.Google Scholar
23. Kanerva, M, Ollgren, J, Lyytikainen, O. Interhospital differences and case-mix in a nationwide prevalence survey. J Hosp Infect 2010;76:135–138.CrossRefGoogle Scholar
24. Rainio, J, Perälä, A, Pelanteri, S. Lonkka- ja polviproteesit 2000–2013. Publications of the National Public Health Institute; 2014.Google Scholar
25. Fukuda, H, Kuroki, M. The development of statistical models for predicting surgical site infections in Japan: toward a statistical model-based standardized infection ratio. Infect Control Hosp Epidemiol 2016;37:260–271.CrossRefGoogle Scholar
26. Gohil, SK, Datta, R, Cao, C, et al. Impact of hospital population case-mix, including poverty, on hospital all-cause and infection-related 30-day readmission rates. Clin Infect Dis 2015;61:1235–1243.CrossRefGoogle ScholarPubMed
27. 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
28. Calderwood, MS, Kleinman, K, Murphy, MV, Platt, R, Huang, SS. Improving public reporting and data validation for complex surgical site infections after coronary artery bypass graft surgery and hip arthroplasty. Open Forum Infect Dis 2014;1:106.CrossRefGoogle ScholarPubMed
29. Lower, HL, Dale, H, Eriksen, HM, Aavitsland, P, Skjeldestad, FE. Surgical site infections after hip arthroplasty in Norway, 2005–2011: influence of duration and intensity of postdischarge surveillance. Am J Infect Control 2015;43:323–328.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Skufca supplementary material

Figure

Download Skufca supplementary material(Image)
Image 8.2 MB
Supplementary material: PDF

Skufca supplementary material

Table

Download Skufca supplementary material(PDF)
PDF 157.5 KB