Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network.
OBJECTIVE
To examine the association between hospital operation volume and surgeon operation volume and the risk of surgical site infection (SSI).


METHODS
Prospective, multicenter cohort study based on surveillance data.


METHODS
Data were obtained from the Dutch surveillance network for nosocomial infections (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]) on 9 different types of orthopedic surgery, general surgery, and gynecology procedures performed during 1996-2003. Multilevel logistic regression analysis was performed to assess the independent effect of hospital volume and surgeon volume on SSI risk.


RESULTS
Hospital volume was not significantly associated with SSI risk for any of the selected procedures. Low surgeon volume was associated with an increased risk for an infection for 7 of 9 types of procedures, although this effect was statistically significant only for knee arthroplasty. For 4 procedures, the odds of exceeding the 75th percentile for duration of surgery were greater when the surgeon volume was low than when the surgeon volume was moderate or high.


CONCLUSIONS
Patients operated on by surgeons with a low operation volume seem to have a higher risk of developing an SSI with some procedures, particularly knee arthroplasty. The higher SSI risk for surgeons with a low operation volume is possibly partly mediated by the longer duration of surgery, a well-known risk factor for development of SSI.
Muilwijk
Jan
J
National Institute of Public Health and the Environment, Centre for Infectious Disease Epidemiology, Bilthoven, The Netherlands. Jan.Muilwijk@rivm.nl
van den Hof
Susan
S
Wille
Jan C
JC
D019645:Arthroplasty, Replacement, Knee / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D013502:General Surgery / Q000145:classification / Q000592:standards* / Q000706:statistics & numerical data*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000145:classification / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D009426:Netherlands / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000145:classification / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D018571:Sentinel Surveillance; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013997:Time Factors; D014600:Utilization Review; D016526:Workload / Q000145:classification / Q000706:statistics & numerical data*