Short Report
Can hospital discharge diagnoses be used for surveillance of surgical-site infections?

https://doi.org/10.1016/j.jhin.2003.12.022Get rights and content

Abstract

The aim of this study was to assess the data quality of postoperative infections in a hospital discharge registry in the Emilia-Romagna region of Italy. Data from a prospective regional study of postoperative infections in 6158 patients from 31 of the 36 public hospitals of the region were compared with data from the regional hospital discharge registry, using different classes of ICD-9-CM codes. The sensitivity of the hospital discharge database for postoperative surgical infections was 10% when ICD-9-CM codes directly indicative of postoperative infectious complications were used. When non-specific codes of postoperative complications, not necessarily of infectious origin, were added, the sensitivity reached 21%. At present, the hospital discharge registry is not suited for surveillance of hospital-acquired infection.

Introduction

Surveillance of surgical-site infection is recognized as an important component of quality improvement programmes and infection prevention. Active surveillance, however, is extremely labour intensive and tends to be conducted in selected units only.1 Hospital discharge registries may present a more effective alternative, but few studies exist that have evaluated this.2., 3., 4. We report our evaluation of the quality of a regional hospital discharge database (HDD) for the registration of postoperative infections in surgical patients, using data collected through a prospective regional survey.

Section snippets

Methods

This study was based on the linkage of data collected during a prospective survey conducted in the year 2001 in the Emilia-Romagna region5 with a regional HDD,5 involving 31 of the 36 (88%) public hospitals. Data were actively collected for one month on all patients undergoing an operation included in any of the 44 National Nosocomial Infection Surveillance (NNIS)1 categories. Overall, 6167 operations were followed up, representing 37% of all the surgical operations performed during the study

Results

Among the 6158 patients involved in our prospective regional study, corresponding to 6167 surgical operations (nine patients had undergone more than one procedure), 206 SSIs were diagnosed by active surveillance (97 during hospital stay and 109 post-discharge). For 6120 patients (99.4%), the corresponding hospital discharge record in the regional database was identified: in 97 (1.5%) an SSI had been diagnosed during hospital stay. Table I shows the comparison between the SSIs identified through

Discussion

According to the results of this study, the quality of HDD for the surveillance of SSIs in the Emilia Romagna region is very low. In contrast, Hebden3 reported encouraging results for sternal infections in patients undergoing coronary artery by-pass grafting, as did Cadwallader et al.3 in Australia in patients undergoing orthopaedic surgery. Madsen et al. in Denmark4 reported a 20% sensitivity of HDD for hospital sepsis.

The observation that 14 patients with SSIs, according to the HDD, were not

Acknowledgements

We thank Massimo Clò for his assistance with the linkage between the regional HDD and the study database and Federica Sarti for her assistance in the preparation of the manuscript.

References (8)

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