An apparent excess of operative site infections: analyses to evaluate false-positive diagnoses.
OBJECTIVE
To investigate an apparent excess of operative site infections (OSI) reported according to doctor's diagnosis (presumptive OSI) by applying objective criteria for classification (documented OSI). To examine potential consequences of habitual overdiagnosis of OSI.


METHODS
A case-control design was used to examine the clinical course of 18 case patients (12 presumptive OSI, six documented OSI) and 18 matched controls. Comparisons also were made between presumptive and documented OSI patients.


METHODS
A nonteaching community hospital.


METHODS
Thirty-six patients having laminectomies done by the same surgeon.


METHODS
Implementation of objective criteria for diagnosis of confirmed OSI and reclassification of presumptive OSI patients.


RESULTS
Postoperatively, the frequency of specific adverse events within the operative site (including postoperative hematoma or bleeding; wound necrosis, dehiscence, or sinus tract; and dural tear) was 83% for documented OSI patients, contrasted with 16.7% for presumptive OSI patients (P < .01) and controls (P = .007). Median days of inpatient stay were 27 for documented OSI, contrasted with 9.5 for presumptive OSI (P = .01) and 7 for controls (P < .001).


CONCLUSIONS
Documented OSI patients were found to have significantly more adverse findings and longer lengths of stay than presumptive OSI patients or controls. The similarity of findings for presumptive OSI patients and controls suggests that the apparent excess frequency of OSI was caused by incorrect diagnosis. Whereas doctor's diagnosis may be useful as an initial screen for OSI, use of objective criteria for confirming OSI may avert the consequences of overdiagnosis including excessive length of stay and unnecessary therapy, which lead to elevated healthcare costs and threaten a physician's practice.
Ehrenkranz
N J
NJ
Florida Consortium for Infection Control, University of Miami School of Medicine, FL 33143, USA.
Richter
E I
EI
Phillips
P M
PM
Shultz
J M
JM
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005161:Facility Regulation and Control; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration*; D007430:Intraoperative Care; D007796:Laminectomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D016017:Odds Ratio; D011182:Postoperative Care; D012189:Retrospective Studies; D012308:Risk Management; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*
D000900:Anti-Bacterial Agents