title: Accounting for incomplete postdischarge follow-up during surveillance of surgical site infection by use of the National Nosocomial Infections Surveillance system's risk index.
abstract: OBJECTIVE
  We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index.
  
  
  METHODS
  Retrospective cohort study that used data prospectively collected from 1993 through 2006.
  
  
  METHODS
  Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil.
  
  
  METHODS
  Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies, and 6,892 laparotomies.
  
  
  METHODS
  For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated.
  
  
  RESULTS
  The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations on the genitourinary system or after a cholecystectomy.
  
  
  CONCLUSIONS
  Compared with the NNIS-based model, the modified NNIS-based model added potentially useful clinical information regarding most of the operative procedures. Further work is warranted to evaluate this method for accounting for incomplete postdischarge follow-up during surveillance of SSI.
authors.affiliation: Health Sciences Postgraduate Course, Medicine High School, Federal University of Minas Gerais, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil. fernandobiscione@yahoo.com.ar
authors.forename: Fernando Martín
authors.initials: FM
authors.lastname: Biscione
authors.forename: Renato Camargos
authors.initials: RC
authors.lastname: Couto
authors.forename: Tânia M G
authors.initials: TM
authors.lastname: Pedrosa
mesh_terms: D001938:Brazil; D003428:Cross Infection; D005260:Female; D006801:Humans; D016015:Logistic Models; D010351:Patient Discharge; D011159:Population Surveillance / Q000379:methods*; D011182:Postoperative Care / Q000592:standards; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000145:classification / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control