Urgency of surgery as an indicator for the occurrence of surgical site infections: data from over 100,000 surgical procedures

2021 ◽  
Author(s):  
Seven Johannes Sam Aghdassi ◽  
Christin Schröder ◽  
Petra Gastmeier
Keyword(s):  
Surgical Procedures ◽  
Surgical Site Infections

scholarly journals Administrative Coding Methods Impact Surgical Site Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s111-s112
Author(s):  
Mohammed Alsuhaibani ◽  
Mohammed Alzunitan ◽  
Kyle Jenn ◽  
Daniel Diekema ◽  
Michael Edmond ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Surgical Procedures ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
Abdominal Hysterectomy ◽  
Absolute Difference ◽  
Coding Method ◽  
The Impact

Background: Surveillance for surgical site infections (SSI) is recommended by the CDC. Currently, colon and abdominal hysterectomy SSI rates are publicly available and impact hospital reimbursement. However, the CDC NHSN allows surgical procedures to be abstracted based on International Classification of Diseases, Tenth Revision (ICD-10) or current procedural terminology (CPT) codes. We assessed the impact of using ICD and/or CPT codes on the number of cases abstracted and SSI rates. Methods: We retrieved administrative codes (ICD and/or CPT) for procedures performed at the University of Iowa Hospitals & Clinics over 1 year: October 2018–September 2019. We included 10 procedure types: colon, hysterectomy, cesarean section, breast, cardiac, craniotomy, spinal fusion, laminectomy, hip prosthesis, and knee prosthesis surgeries. We then calculated the number of procedures that would be abstracted if we used different permutations in administration codes: (1) ICD codes only, (2) CPT codes only, (3) both ICD and CPT codes, and (4) at least 1 code from either ICD or CPT. We then calculated the impact on SSI rates based on any of the 4 coding permutations. Results: In total, 9,583 surgical procedures and 180 SSIs were detected during the study period using the fourth method (ICD or CPT codes). Denominators varied according to procedure type and coding method used. The number of procedures abstracted for breast surgery had a >10-fold difference if reported based on ICD only versus ICD or CPT codes (104 vs 1,109). Hip prosthesis had the lowest variation (638 vs 767). For SSI rates, cesarean section showed almost a 3-fold increment (2.6% when using ICD only to 7.32% with both ICD & CPT), whereas abdominal hysterectomy showed nearly a 2-fold increase (1.14% when using CPT only to 2.22% with both ICD & CPT codes). However, SSI rates remained fairly similar for craniotomy (0.14% absolute difference), hip prosthesis (0.24% absolute difference), and colon (0.09% absolute difference) despite differences in the number of abstracted procedures and coding methods. Conclusions: Denominators and SSI rates vary depending on the coding method used. Variations in the number of procedures abstracted and their subsequent impact on SSI rates were not predictable. Variations in coding methods used by hospitals could impact interhospital comparisons and benchmarking, potentially leading to disparities in public reporting and hospital penalties.Funding: NoneDisclosures: None

Surgical Site Infections Rates in More Than 13,000 Surgical Procedures in Three Cities in Peru: Findings of the International Nosocomial Infection Control Consortium

2015 ◽  
Vol 16 (5) ◽  
pp. 572-576 ◽  
Author(s):  
Fernando M. Ramírez-Wong ◽  
Teodora Atencio-Espinoza ◽  
Victor D. Rosenthal ◽  
Eliza Ramirez ◽  
Socorro L. Torres-Zegarra ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Surgical Procedures ◽  
Surgical Site Infections

scholarly journals Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands

2006 ◽  
Vol 27 (08) ◽  
pp. 809-816 ◽  
Author(s):  
Judith Manniën ◽  
Jan C. Wille ◽  
Ruud L. M. M. Snoeren ◽  
Susan van den Hof
Keyword(s):  
Medical Record ◽  
Surgical Procedures ◽  
Clinical Symptoms ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Abdominal Hysterectomy ◽  
Surveillance Network ◽  
Femorotibial Bypass ◽  
Registration Card

Objective. To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. Design. Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record. Setting. Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004. Results. We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%). Conclusions. For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

scholarly journals Surgical site infection incidence and risk factors in thoracic surgical procedures: A 12-year prospective cohort study

2019 ◽  
Vol 13 (03) ◽  
pp. 212-218
Author(s):  
Vlado S Cvijanovic ◽  
Aleksandar S Ristanović ◽  
Nebojsa T Maric ◽  
Natasa V Vesovic ◽  
Vanja V Kostovski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracic Surgery ◽  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Thoracic Surgical Procedures ◽  
Wound Contamination ◽  
Surgical Site Infection Incidence ◽  
Independent Risk Factors ◽  
American Society ◽  
Duration Of Operation

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

scholarly journals 567. Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Scott Arden
Keyword(s):  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Infection Risk ◽  
Practice Change ◽  
Screening Tests ◽  
Contact Precautions ◽  
Chlorhexidine Bathing ◽  
Before And After ◽  
The Cost ◽  
The Impact

Abstract Background Nasal decolonization with mupirocin to reduce infection risk, has been associated with mupirocin-resistant Staphylococcus aureus (SA). A community hospital identified two patients colonized with methicillin and mupirocin-resistant SA (MRSA), one scheduled for surgery, one for inpatient IV antibiotic therapy. Instead of mupirocin, an alcohol based nasal antiseptic was applied to these patients twice daily for 5 days, resulting in a negative MRSA nasal screening test in both patients. Neither patient developed an infection during or after treatment. Building on this success, a plan was made to assess the impact of universal nasal decolonization to replace screening and contact precautions for MRSA colonized patients, and to reduce surgical site infections (SSI). Methods A 12-month project using a before and after design, was initiated in April 2018. The project involved twice daily application of alcohol-based nasal antiseptic for all inpatients, and preoperatively for all surgical patients in addition to existing preoperative chlorhexidine bathing. No other practice change was made during this period. Assessment of impact was planned by comparing the incidence of MRSA bacteremia and SSI at baseline (2017) and after project implementation, in addition to costs avoided with reduction of nasal screening and CP. Results Compared with baseline, between April 2018 and March 2019, there was a decrease in MRSA bacteremia from 3/1,000 patient-days to 0/1,000 patient-days, a reduction in CP from 3.78 to 1.53/1,000 patient-days, a reduction in nasal screens from 3,874 to 605, and a reduction of all-cause (Gram-negative and Gram-positive) SSI after all surgical procedures from 3/4,313 procedures to 0/4,872 procedures. After accounting for the cost of the nasal antiseptic, the reduction in gowns, gloves and nasal screening tests resulted in $104,099.91costs avoided. Conclusion House-wide application of alcohol-based nasal antiseptic in place of screening and contact precautions, resulted in a reduced incidence of both MRSA bacteremia and SSI for all types of surgical procedures, in addition to significant costs avoided. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands

2006 ◽  
Vol 27 (8) ◽  
pp. 809-816 ◽  
Author(s):  
Judith Manniën ◽  
Jan C. Wille ◽  
Ruud L. M. M. Snoeren ◽  
Susan van den Hof
Keyword(s):  
Medical Record ◽  
Surgical Procedures ◽  
Clinical Symptoms ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Abdominal Hysterectomy ◽  
Surveillance Network ◽  
Femorotibial Bypass ◽  
Registration Card

Objective.To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.Design.Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.Setting.Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.Results.We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).Conclusions.For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

scholarly journals Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

2021 ◽  
pp. 229255032199700
Author(s):  
Peter Mankowski ◽  
Abhiram Cherukupalli ◽  
Karen Slater ◽  
Nick Carr
Keyword(s):  
Antibiotic Prophylaxis ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Surgical Prophylaxis

Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

Harmonized procedure coding system for surgical procedures of five European countries (Preprint)

2021 ◽  
Author(s):  
Sibylle Mellinghoff ◽  
Carolin Bruns ◽  
Rouvier Al-Monajjed ◽  
Florian Cornely ◽  
Maria Grosheva ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Surgical Procedure ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
European Countries ◽  
Surgical Approaches ◽  
Coding System ◽  
Ongoing Surveillance ◽  
The Uk ◽  
Procedure Codes

BACKGROUND Surgical site infections (SSI) are frequent hospital acquired complications. Ongoing surveillance pro-grams evaluate the incidence of SSI worldwide. However, incidence rates are only estimated by the analyses of indicator procedures to date. OBJECTIVE To further assess procedure specific SSI rates, the harmonization of international procedure codes is necessary. METHODS We compared existing surgical procedure coding systems of five European countries (France, Ger-many, Italy, Spain, and the UK) and distributed a simplified code to all existing country-specific codes. Based on mode and extent of the surgical procedure and the surgical site, 153 codes were defined, distributed, and characterized within the presented coding system. Additionally, minimally invasive, laparoscopic or open surgical approaches were considered, whereas eye surgery and di-agnostic procedures were excluded. RESULTS A total number of 15432 surgical procedures were assigned to 153 SALT codes from 10 specialties. Almost 4000 (26%) procedure codes from the SALT coding system were classified as orthopaedic and trauma surgeries, thus this medical field represents the most diverse group within the SALT coding system, followed by abdominal surgical procedures with 2390 (15%) procedure codes. CONCLUSIONS The Europe-wide SALT procedure code gives the opportunity to harmonize big data sets containing surgical procedures from international centres, and may simplify comparability of future interna-tional trial findings.

scholarly journals The Impact of Depth of Infection and Postdischarge Surveillance on Rate of Surgical-Site Infections in a Network of Community Hospitals

2012 ◽  
Vol 33 (3) ◽  
pp. 276-282 ◽  
Author(s):  
David Y. Ming ◽  
Luke F. Chen ◽  
Becky A. Miller ◽  
Daniel J. Sexton ◽  
Deverick J. Anderson
Keyword(s):  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Inpatient Setting ◽  
Community Hospitals ◽  
Comparative Performance ◽  
Median Proportion ◽  
Inpatient Settings ◽  
The Impact ◽  
Reporting Method ◽  
Performance Ranking

Objective.To describe the epidemiology of surgical-site infections (SSIs) in community hospitals and to explore the impact of depth of SSI, healthcare location at the time of diagnosis, and variations in surveillance practices on the overall rate of SSI.Design.Retrospective cohort study.Setting.Thirty-seven community hospitals in the southeastern United States.Patients.Consecutive sample of patients undergoing surgical procedures between July 1, 2007, and December 31, 2008.Methods.ANOVA was used to compare rates of SSIs, and the F test was used to compare the distribution of rates of SSIs. Wilcoxon rank-sum was used to test for differences in performance rankings of hospitals.Results.Following 177,706 surgical procedures, 1,919 SSIs were identified (incidence, 1.08 per 100 procedures). Sixty-four percent (1,223 of 1,919) of these were identified as complex SSIs; 87% of the complex SSIs were diagnosed in inpatient settings. The median proportion of superficial-incisional SSIs was 37% (interquartile range, 29.6%–49.5%). Postdischarge SSI surveillance was variable, with 58% of responding hospitals using surgeon letters. As reporting focus was narrowed from all SSIs to complex SSIs (incidence, 0.69 per 100 procedures) and, finally, to complex SSIs diagnosed in the inpatient setting (incidence, 0.51 per 100 procedures), variance in rates changed significantly (P = .02). Performance ranking of individual hospitals, based on rates of SSIs, differed significandy, depending on the reporting method utilized (P = .0006).Conclusions.Inconsistent reporting mediods focused on variable depths of infection and healthcare location at time of diagnosis significandy impact rates of SSI, distribution of rates of SSI, and hospital comparative-performance rankings. We believe that public reporting of SSI rates should be limited to complex SSIs diagnosed in the inpatient setting.Infect Control Hosp Epidemiol 2012;33(3):276-282

Sign in / Sign up

Export Citation Format

Share Document