Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

Abstract

OBJECTIVETo assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validationMETHODSInfection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency).RESULTSUpon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy.CONCLUSIONSClaims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.Infect Control Hosp Epidemiol 2017;38:1091–1097

National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians

“…Indeed, detection of SSI cases, based on claims data that might have been omitted during routine surveillance, may be used as an initial screening technique, prior to the more rigorous investigation of medical records [18]. Calderwood et al [19] assessed regularly collected electronic Medicare claims data to obtain postoperative SSI data. He developed an SSI indicator coding system for specific surgeries and found that SSI detection rate, based on claims data, was approximately 1.8-4.7 times higher.…”

The Cost of Surgical Site Infections after Colorectal Surgery in the United States from 2001 to 2012: A Longitudinal Analysis

“…Different approaches in the inclusion and exclusion criteria have been widely described in the literature and have the potential to result in overreporting or underreporting of certain diagnoses. 36 This could occur because of the differences in coding standards specific to the United States institutions and result in a limited number of diagnoses, which could be listed per patient. These differences have the potential to be particularly challenging for any scientific study because of the financial penalties imposed by the Centers for Medicare and Medicaid Services (CMS) for hospital-acquired conditions that rely on the diagnosis codes and, therefore, may incentivize underreporting of ICD-9 codes associated with SSIs.…”

Sepsis in the Context of Nonventilator Hospital-Acquired Pneumonia

“…34,35 Data indicate that currently used ACD, specifically ICD-9 coding, may have limited and variable accuracy for the identification and surveillance of hospital-acquired infection. In a recent study 36 conducted at 47 acute care hospitals in California, researchers looked at both traditional surveillance and claims-based surveillance for surgical site infection. These researchers found that the overall sensitivity for traditional surveillance was 50% whereas that of claims-based surveillance was 84%, and that surveillance using both ICD-9 and ICD-10 codes provided a standardized approach.…”

“…These researchers found that the overall sensitivity for traditional surveillance was 50% whereas that of claims-based surveillance was 84%, and that surveillance using both ICD-9 and ICD-10 codes provided a standardized approach. 36 Nevertheless, given that the identification of surgical site infection can occur in either the acute care setting before discharge or in the outpatient setting where the surveillance process is less defined, these findings may have limited applicability for the acute care infection surveillance used to identify NV-HAP.…”

“…37,38 All things considered, because ACD is the approach currently used by US hospitals for payment, ACD will continue to serve as the common benchmark for health care-associated infection surveillance and payment until better methods can be developed and assessed. 36 The transition in US health care from ICD-9 to ICD-10 and the increased number of diagnostic codes associated with ICD-10 should provide improvements in the coding accuracy for ACD.…”