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

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.

Development of machine learning models for the detection of surgical site infections following total hip and knee arthroplasty: a multicenter cohort study

“…While our study’s TKA and THA rates were slightly lower than the CDC and ECDC reported rates [ 2 , 24 , 25 ]. This finding is consistent with previously published studies [ 26 ]. The observed decrease in the incidence of SSIs throughout the study period might have resulted from uniform provincial surveillance initiated by the Alberta Health Services IPC program starting in March 2012 [ 27 ].…”

Clinical Significance of Protective Motivation Intervention Nursing on Functional Recovery of Patients after Hip Arthroplasty

“…At present, the theory of protective motivation is mainly used in the prediction and intervention of health behavior, and it has also been widely used in the selfmanagement of chronic diseases. Domestic studies have applied this theory to chronic diseases and achieved good results [8]. Based on this, this study focuses on the effect of the protective motivation intervention nursing model on the functional recovery of patients after hip arthroplasty and its clinical significance.…”

Automating surveillance for healthcare-associated infections: Rationale and current realities (Part I/III)

“…Despite detailed instructions provided by the NHSN, concerns regarding subjective application of definitions have been raised and discrepancies have been noted when comparing NHSN outcomes to other surveillance initiatives, notably the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). 15,36,37 Benefits of automation: Speed, accuracy, and efficiency Despite the requirement for chart review to apply the NHSN definition for device-associated infections and SSIs, automating aspects of surveillance can, through extraction of the available electronic elements, restrict the possible HAI cases that require chart review to only those that would otherwise meet the NHSN definition. In the CAUTI example, by applying elements 1 and 3, an automated system limits the total cases that require chart review.…”