Use of Censored Data to Monitor Surgical-Site Infections

Thibon, Pascal; Parienti, Jean Jacques; Borgey, F.; Prieur, A. Le; Bernet, C.; Branger, B.; Coutour, X. Le

doi:10.1086/502067

Cited by 19 publications

(16 citation statements)

References 13 publications

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“…However, the reliability and validity of infection reporting must be assessed regularly [23]. The main obstacles in interpreting SSI rates are variations in the diagnosis of SSI and in postoperative follow-up duration [24].…”

Section: Discussionmentioning

confidence: 99%

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

et al. 2013

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ObjectiveAlthough surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe.MethodsTwelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale.ResultsIntra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00–0.35) to 0.65 (0.45–0.82). Inter-specialty agreement varied from 0.04 (0.00–0.62) in to 0.55 (0.37–0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14–0.42) and good for ICPs (0.41, 0.28–0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00–0.10) to 0.50 (0.45–0.55) and was not improved by reading SSI definition.ConclusionAmong ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.

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Section: Discussionmentioning

confidence: 99%

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

et al. 2013

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“…This observation is supported by Thibon et al . (35), who advise that if results obtained from different teams are to be comparable, then monitoring protocols must also be harmonised. Table 1 suggests that not all studies identified who was responsible for observation.…”

Section: Discussionmentioning

confidence: 99%

Surgical site infection – a European perspective of incidence and economic burden

Leaper

Goor

Reilly

et al. 2004

International Wound Journal

270

168

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This retrospective review of reported surgical site infection (SSI) rates in Europe was undertaken to obtain an estimated scale of the problem and the associated economic burden. Preliminary literature searches revealed incomplete datasets when applying the National Nosocomial Infection Surveillance System criteria. Following an expanded literature search, studies were selected according to the number of parameters reported, from those identified as critical for accurate determination of SSI rates. Forty-eight studies were analysed. None of the reviewed studies recorded all the data necessary to enable a comparative assessment of the SSI rate to be undertaken. The estimated range from selected studies analysed varied widely from 1.5-20% - a consequence of inconsistencies in data collection methods, surveillance criteria and wide variations in the surgical procedures investigated - often unspecified. SSIs contribute greatly to the economic costs of surgical procedures - estimated range: 1.47-19.1 billion Euro dollars. The analysis suggests that the true rate of SSIs, currently unknown, is likely to have been previously under-reported. Consequently, the associated economic burden is also likely to be underestimated. A significant improvement in study design, data collection, analysis and reporting will be necessary to ensure that SSI baseline rates are more accurately assessed to enable the evaluation of future cost-effective measures.

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“…In the NNIS risk index, patients not reached by post discharge surveillance are counted as uninfected (provided that they did not develop the infection during hospital stay) [31] , artificially reducing the measured SSI risk. The problem of incomplete followup after discharge has been largely overlooked in SSI riskmodeling, and there are few reports in the literature in which the problem of missing post discharge information has been explicitly accounted for [37][38][39][40][41][42] . In a recent study [43] , we have found that incorporating a post discharge surveillance indicator to the NNIS risk index can add potentially useful clinical information, although concerns about the mechanism that leads to missing post discharge information must be borne in mind.…”

Section: The National Nosocomial Infections Surveillance Risk Indexmentioning

confidence: 99%

Rates of surgical site infection as a performance measure: Are we ready?

Biscione¹

2009

WJGS

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With the introduction of quality assurance in health care delivery, there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities. Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs. Adverse post-operative events, and very especially surgical site infection (SSI) rates after specific procedures, gained popularity as hospital quality indicators in the 1980s. For a SSI rate to be considered a valid indicator of the quality of care, it is essential that a proper adjustment for patient case mix be performed, so that meaningful comparisons of SSI rates can be made among surgeons, institutions, or over time. So far, a significant impediment to developing meaningful hospital-acquired infection rates that can be used for intra-and inter-hospital comparisons has been the lack of an adequate means of adjusting for case mix. This paper discusses what we have learned in the last years regarding risk adjustment of SSI rates for provider performance assessment, and identifies areas in which significant improvement is still needed.

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Use of Censored Data to Monitor Surgical-Site Infections

Cited by 19 publications

References 13 publications

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

Surgical site infection – a European perspective of incidence and economic burden

Rates of surgical site infection as a performance measure: Are we ready?

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