Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol.
BACKGROUND
The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections.


OBJECTIVE
To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS.


METHODS
Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated.


RESULTS
The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor.


CONCLUSIONS
Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.
Merle
V
V
Department of Epidemiology and Public Health, Rouen University Hospital-Charles Nicolle, Rouen, France.
Germain
J M
JM
Chamouni
P
P
Daubert
H
H
Froment
L
L
Michot
F
F
Teniere
P
P
Czernichow
P
P
D000368:Aged; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D003625:Data Collection; D003627:Data Interpretation, Statistical; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D015983:Selection Bias; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014600:Utilization Review / Q000592:standards*