Improving Surveillance for Surgical Site Infections Following Total Hip and Knee Arthroplasty Using Diagnosis and Procedure Codes in a Provincial Surveillance Network

Abstract

OBJECTIVE To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following primary elective total hip or knee arthroplasty. DESIGN Retrospective cohort study. SETTING All acute care facilities in Alberta, Canada. METHODS Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection control professional at the acute care facility where the patient was identified with a diagnosis or procedure code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI definition. The performance of traditional surveillance methods and administrative data-triggered medical chart review was assessed. RESULTS Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42% vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their procedure facility. Administrative data-triggered medical chart review with infection control professional confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs identified by administrative data resulted in sensitivity of 90% and specificity of 99%. CONCLUSION Medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at nonprocedure facilities. Infect Control Hosp Epidemiol 2016;37:699-703.

Validation of semiautomated surgical site infection surveillance using electronic screening algorithms in 38 surgery categories

“…We confirmed that the semiautomated system can detect SSI cases with high sensitivity while significantly reducing the workload of IPs. In contrast to previous studies that only covered limited types of surgery, [11][12][13][14][15] our study included 38 categories of surgery. Validation of the semiautomated surveillance system was possible because of the large, conventional SSI surveillance database that had already been built, which was used as a reference standard.…”

“…[8][9][10] Such semiautomated electronic surveillance systems have been reported to reduce the workload for chart reviews while maintaining a high sensitivity of SSI detection for specific surgical procedures such as total hip and knee arthroplasty. [11][12][13][14][15] However, previous studies have been limited to certain types of surgery. The goal of this study was to verify the validity of semiautomated SSI surveillance using electronic screening algorithms in 38 categories of surgery.…”

Interhospital Comparison of Surgical Site Infection Rates in Orthopedic Surgery

“…Second, we should restrict our comparisons to deep SSI rates and should systematically utilize readmission data from the existing electronic hospital information systems for identifying cases of deep SSIs, as previously recommended. 27,28 There is a risk of missing SSIs due to incomplete automated data harvesting or because the patient was readmitted to another hospital. 11,21 However, without sacrificing sensitivity, 27,29 identification of potential readmitted deep SSIs can provide a more consistent and less resource-demanding method of case finding among hospitals 27 than various methods used to detect superficial SSIs.…”

Association of Partial Hip Replacement With Higher Risk of Infection and Mortality in France

“…In multivariate analysis, PHR was associated with a higher risk of SSI than THR (hazard ratio, As recently checked in Canada, medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. 9 It improves casefinding by increasing SSI identification, and it identifies SSIs presenting at nonprocedure facilities. 9 At first, on the basis of a nationwide hospital information system of more than 400,000 procedures, our study confirmed the significant increase of crude SSI incidence previously reported in a regional subset during the same study period.…”

“…9 It improves casefinding by increasing SSI identification, and it identifies SSIs presenting at nonprocedure facilities. 9 At first, on the basis of a nationwide hospital information system of more than 400,000 procedures, our study confirmed the significant increase of crude SSI incidence previously reported in a regional subset during the same study period. 3 An association of SSI coding with new hospital financial incentives has been suspected since the labeling of French medical centers in 2009 for rates of complicated bone and joint infection, 2 but this trend does exist in other countries, making this argument insufficient to explain such an increase.…”