title: Use of Medicare diagnosis and procedure codes to improve detection of surgical site infections following hip arthroplasty, knee arthroplasty, and vascular surgery.
abstract: OBJECTIVE
  To evaluate the use of routinely collected electronic health data in Medicare claims to identify surgical site infections (SSIs) following hip arthroplasty, knee arthroplasty, and vascular surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Four academic hospitals that perform prospective SSI surveillance.
  
  
  METHODS
  We developed lists of International Classification of Diseases, Ninth Revision, and Current Procedural Terminology diagnosis and procedure codes to identify potential SSIs. We then screened for these codes in Medicare claims submitted by each hospital on patients older than 65 years of age who had undergone 1 of the study procedures during 2007. Each site reviewed medical records of patients identified by either claims codes or traditional infection control surveillance to confirm SSI using Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. We assessed the performance of both methods against all chart-confirmed SSIs identified by either method.
  
  
  RESULTS
  Claims-based surveillance detected 1.8-4.7-fold more SSIs than traditional surveillance, including detection of all previously identified cases. For hip and vascular surgery, there was a 5-fold and 1.6-fold increase in detection of deep and organ/space infections, respectively, with no increased detection of deep and organ/space infections following knee surgery. Use of claims to trigger chart review led to confirmation of SSI in 1 out of 3 charts for hip arthroplasty, 1 out of 5 charts for knee arthroplasty, and 1 out of 2 charts for vascular surgery.
  
  
  CONCLUSIONS
  Claims-based SSI surveillance markedly increased the number of SSIs detected following hip arthroplasty, knee arthroplasty, and vascular surgery. It deserves consideration as a more effective approach to target chart reviews for identifying SSIs.
authors.affiliation: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA. mcalderwood@partners.org
authors.forename: Michael S
authors.initials: MS
authors.lastname: Calderwood
authors.forename: Allen
authors.initials: A
authors.lastname: Ma
authors.forename: Yosef M
authors.initials: YM
authors.lastname: Khan
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Yokoe
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
authors.forename: Kurt
authors.initials: K
authors.lastname: Stevenson
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008499:Medical Records; D006278:Medicare; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects