Can We Define Surgical Site Infection Accurately in Colorectal Surgery?

Abstract

This study highlights the difficulty in defining SSI in colon and rectal surgery, which oftentimes is subjective and difficult to discern from the medical record. According to these preliminary data from our institution, there is poor reliability between clinical reviewers in defining SSI on the basis of the CDC criteria, which has serious implications. The interpretation of clinical trials may be jeopardized if we cannot define SSI accurately. Furthermore, according to current CDC definitions and infection tracking strategies, these data suggest that the institutional incidence of SSI may not be a reliable measure by which to compare institutions. Better methods for defining SSI should be implemented if these data are made publicly available and tied to performance measures.

Open Surgical Incisions After Colorectal Surgery Improve Quality Metrics, But Do Patients Benefit?

“…Although the definition is standardized across the dataset, there clearly exists heterogeneity in what is considered and documented as a wound infection in the medical chart, which is at the discretion of each patient’s healthcare providers, as has been previously shown. 21 Negative pressure wound therapy (eg wound vac) techniques are commonly used in cases where delayed/secondary wound closure is employed, but this information was not available in the dataset. Delayed wound closure was much more commonly performed in patients with worse underlying medical conditions including the presence of preoperative sepsis, and those with contaminated/dirty wounds, therefore interpretations of direct comparison are limited to the matched cohort and care should be taken when extrapolating these findings.…”

A Comparative Analysis of Surgical Wound Infection Methods: Predictive Values of the CDC, ASEPSIS, and Southampton Scoring Systems in Evaluating Breast Reconstruction Surgical Site Infections

“…Additional points are awarded for antibiotic treatment, drainage of pus under local anesthesia, debridement of the wound under general anesthesia, isolation of bacteria, and stay as inpatient prolonged over 14 days. Scores are grouped into 4 categories: satisfactory healing (0-10), disturbance of healing (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), minor SSI (21-30), moderate SSI (31-40), and severe SSI (>40). The original ASEPSIS score is meant to evaluate the surgical site for infections from day 5 to 7 postoperatively.…”

Wound Concerns and Healthcare Consumption of Resources after Colorectal Surgery: An Opportunity for Innovation?

“…A discrepancy between the NSQIP and surgeon SSI capture rate is evident. Previously, we found poor inter-rater reliability among surgeons and NSQIP in identifying SSI according to CDC criteria [21,22]. In the majority of cases, omissions by NSQIP were because of lack of clear documentation leading to a very low rate of SSI in the NSQIP database.…”