What Is the Real Rate of Surgical Site Infection?

Abstract

QUESTION ASKED: What is the real rate of surgical site infection (SSI) after surgery for gynecologic malignancy and benign gynecologic disease?SUMMARY ANSWER: Overall SSI rates differed greatly between the University HealthSystem Consortium (UHC), National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) (1.5%, 8.8%, and 2.8% respectively, P , .001) due to wide variation in reporting methodology. Variation was notable among deep (UHC, 0.7%; NSQIP, 4.7%; NHSN, 1.3%; P , .001) and organ space infections (UHC, 0.4%; NSQIP, 4.4%; NHSN, 1.4%; P , .001) as well as when the reporting agencies were compared with institutional chart review by the authors. Also, because of differences in reporting methodology, only 19 cases (24.4%) were included in more than one database and only one case was included in all three databases (1.3%).WHAT WE DID: We compared SSI rates after gynecologic surgery obtained from the UHC, NSQIP and NHSN databases and the reporting methodologies used by these agencies among themselves. We also compared the SSI rates reported by these agencies to the SSI rate obtained from chart review.WHAT WE FOUND: There was significant variation in the rate of SSI after gynecologic surgery reported by national reporting agencies. Variations in reporting methodology also resulted in limited overlap between reporting agencies in identification of cases with SSI. BIAS, CONFOUNDING FACTORS, DRAWBACKS:A limitation of this analysis is that these data are from a single institution and relate to SSI after surgery for gynecologic malignancy and benign gynecologic disease. Results may not be generalizable for the rate of SSI after surgery in other institutions or specialties. Finally, care must be taken when comparing the reported rates of SSI across agencies as there is variation in the denominators on the basis of the differing inclusion and exclusion criteria. REAL-LIFE IMPLICATIONS:There is discordance among national reporting agencies tracking the rate of SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates. When planning an initiative to improve SSI rates and patient outcomes, it is important to assess which metric and reporting method will be most useful and appropriate (Fig). AbstractPurpose Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology.

Development and Validation of an Electronic Postoperative Morbidity Score

“…Risk scores are often used to quantify such information for patients and clinicians . Importantly, how complications are defined may lead to differences in reported incidences; 2 as such, the use of standardized outcome measures is to be advocated. Ongoing work is looking to develop a consensus set of outcomes for perioperative medicine 3 .…”

Surgical site infection metrics: Dissecting the differences between the National Health and Safety Network and the National Surgical Quality Improvement Program

“…The one metric collected by both surveillance systems is SSI. We noticed that at our facility, as has been reported by others, [1][2][3][4][5] NHSN and NSQIP metric reports have often painted conflicting pictures of our hospital's SSI performance as benchmarked against our peers. This discordance has raised questions about the validity of the SSI metric and has threatened to undermine the original intent of the surveillance endeavor, which is to improve care.…”

“…Previous analyses of the lack of concordance between the NHSN and the NSQIP have concluded with a call-to-action to develop a single, universally reliable, surveillance system. [1][2][3] In practice, such a move would be adding yet another method of surveillance to which hospitals would need to allocate more resources. For providers who already feel frustrated by contradictory judgments that have been passed on their practice, confidence in surveillance measures may already be compromised.…”

Prophylactic closed‐incision negative‐pressure wound therapy is associated with decreased surgical site infection in high‐risk colorectal surgery laparotomy wounds

“…The NSQIP provides a standardized assignment of SSI status with uniform 30‐day follow‐up, which will facilitate future comparisons. This is of particular benefit, as it should be noted that there is often significant variability in definitions of SSI and accuracy across data sets .…”