Surgery is a central part of healthcare. It is estimated that approximately 11% of the global burden of diseases can be addressed wholly or partly by surgical care. 1 By its very nature, surgery is considered an invasive procedure and therefore carries inherent risks for patients. Based on World Health Organization data, the crude death rate after major surgery is 0.5% to 5%; up to 25% of surgical inpatients experience post-surgery complications, and surgical care accounts for almost half of all adverse events for inpatients in western countries. 2 There is no shortage of data to document the significant costs associated with surgical complications. 3-5 The World Health Organization estimated that half of surgery-associated harm is preventable. 2 Since its creation in 1913, the American College of Surgeons (ACS) has been relentless in its pursuit of the improvement of health outcomes of patients undergoing surgery. One of the major achievements of the ACS was the creation, testing, and validation of a system that captures and reports risk adjusted outcomes of surgical interventions: The National Surgical Quality Improvement Program (NSQIP). The trigger for the creation of the initial version of NSQIP was a mandate in 1985 from the US federal government (US Congress of Public Law No. 99-166) to monitor surgical outcomes in 133 Veterans Affairs Hospitals. 6 In collaboration with the ACS, the Department of Veterans Affairs conducted the National Veterans Administration Surgical Risk Study between October 1, 1991 and December 31, 1993, with the goal to define performance indicators and clinical variables and delineate how risk adjustment would be conducted. In 1994, the first version of NSQIP was introduced only in Veteran Affairs hospitals, which enabled riskadjusted comparison of surgical complications to be made across 133 hospitals. 7 This original version of NSQIP collected information on post-surgical outcomes and provided surgeon-and hospital-specific scorecards based on objective and rigorous analysis of the data. In light of the patient outcomes data generated by NSQIP, a number of quality improvement initiatives were put in place that led to reductions in mortality and morbidity in the VA hospital system, by 27% and 45%, respectively. 8 Subsequently, the NSQIP program was expanded to include private sector hospitals, with the Patient Safety in Surgery (PSS) study, which ran in parallel in the VA and a set of non-VA hospitals in 2001 to 2004, and showed clear and definite improvements in patient outcomes in both systems. 8 In 2004, NSQIP was officially branded as ACS-NSQIP. In 2005, participation in the private sector program sponsored by the American College of Surgeons (ACS-NSQIP) became available by subscription, while at the same time, the VA program separated from the private sector program and became the VA-sponsored version: VA-SQIP. Since then, the number of hospitals adopting the program has increased on a yearly basis. Over the past 13 years, the number of surgical sites that have adopted ACS-NSQIP...
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.
Background: In Alberta, Canada, surgical site infections (SSIs) following total hip (THR) and knee replacements (TKR) are reported using 2 data sources: infection prevention and control (IPC), which surveys all THR and TKR using NHSN definitions and the Canadian International Classification of Disease, Tenth Revision (ICD-10-CA) codes, and the National Surgical Quality Improvement Program (NSQIP), which uses a systematic sampling process that involves an 8-day cycle schedule, modified NHSN definitions and current procedural terminology (CPT) codes. We compared the similarities and discrepancies in THR/TKR SSI reporting. Methods: A retrospective multisite cohort study of IPC and NSQIP THR/TKR SSI data at 4 hospitals was performed. SSI data were collected between September 1, 2015, and March 31, 2018. Demographic information and complex and total SSIs reported by IPC and NSQIP were compared for both THR and TKR surgeries. To determine whether both data sources reported similar trends over time, total SSIs by quarter were compared. Univariate analyses using a t test for age and the χ2 test for gender for complex SSIs and total SSIs was performed. The Pearson correlation and the Shapiro-Wilk test were used to assess the THR and TKR trends between the 2 data sources. A P value of <.05 was considered significant. Results: Following the removal of duplicates and missing data, 7,549 IPC and 2,037 NSQIP patients, respectively, were compared. Age, gender, and other demographic parameters were not significantly different. Total THR and TKR SSIs per 100 procedures using NSQIP data were significantly higher than the same rates using IPC data: THR, 2.25 versus 0.92 (P < .05) and TKR, 3.43 versus 1.26 (P < .05). Both IPC and NSQIP data indicated increasing total THR SSI rates over time, but with different magnitudes (r = 0.658). For total TKR SSI, the IPC rate decreased, whereas the NSQIP rate increased over the same period (r = 0.374). When superficial SSIs were excluded, the rates reported between IPC and NSQIP data by hospital and by procedure type were more comparable, with trends toward higher rates reported by NSQIP for THR than for TKR: THR, 1.19 versus 0.68 (P = 0.15) and TKR, 0.92 versus 0.80 (P = .68). Conclusions: Different approaches used to monitor SSIs following surgeries may lead to different results and trend patterns. NSQIP reports total SSI rates that are significantly higher than the IPC Alberta orthopedic population predominantly as a result of increased identification of superficial SSIs. Because the diagnosis of superficial SSIs may be less reliable, SSI reporting should focus on complex infections.Funding: NoneDisclosures: None
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