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Detection of Postoperative Surgical-Site Infections: Comparison of Health Plan–Based Surveillance With Hospital-Based Programs

Published online by Cambridge University Press:  02 January 2015

Kenneth E. Sands ,
Deborah S. Yokoe ,
David C. Hooper ,
John L. Tully ,
Teresa C. Horan ,
Robert P. Gaynes ,
Steven L. Solomon  and
Richard Platt
Kenneth E. Sands*
Affiliation:
Centers for Disease Control and Prevention, Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Beth Israel Deaconess Medical Center, Boston, Massachusetts
Deborah S. Yokoe
Affiliation:
Centers for Disease Control and Prevention, Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
David C. Hooper
Affiliation:
Centers for Disease Control and Prevention, Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts Massachusetts General Hospital, Boston, Massachusetts
John L. Tully
Affiliation:
Centers for Disease Control and Prevention, Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Mt. Auburn Hospital, Cambridge, Massachusetts
Teresa C. Horan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Gaynes
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Steven L. Solomon
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Richard Platt
Affiliation:
Centers for Disease Control and Prevention, Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Harvard Medical School, and Harvard Vanguard Medical Associates, Boston, Massachusetts
*
Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
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Abstract

Background:

Review of health plan administrative data has been shown to be more sensitive than other methods for identifying postdischarge surgical-site infections (SSIs), but there has not been a direct comparison between this method and hospital-based surveillance for all infections, including those diagnosed before discharge. We compared these two methods for identifying SSIs following coronary artery bypass graft (CABG) procedures:.

Methods:

We studied 1,352 CABG procedures performed among members of one health plan from March 1993 through June 1997. Health plan administrative records were reviewed based on claims containing diagnoses or procedures suggestive of infection or outpatient dispensing of antibiotics appropriate for SSI. Hospital-based surveillance information was also reviewed. SSI rates were calculated based on the total events identified by either mechanism.

Results:

Postdischarge information was reviewed for 328 (85%) of 388 procedures. SSIs were confirmed in 167 patients (13% overall risk of confirmed SSI; range, 3% to 14% in the 5 hospitals). The overall sensitivity of hospital-based surveillance was 49.7% (83 of 167), and that of health plan data was 71.8% (120 of 167). There was no significant difference among hospitals in the sensitivity of either surveillance mechanism.

Conclusions:

Surveillance based on health plan data identified more postoperative infections, including those occurring before discharge, than did hospital-based surveillance. Screening administrative data and pharmacy activity may be an important adjunct to SSI surveillance, allowing efficient comparison of hospital-specific rates. Interpretation of differences among hospitals' infection rates requires case mix adjustment and understanding of variations in hospitals' discharge diagnosis coding practices

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 10 , October 2003 , pp. 741 - 743
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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