title: Improved risk adjustment in public reporting: coronary artery bypass graft surgical site infections.
abstract: OBJECTIVE
  The objective was to develop a new National Healthcare Safety Network (NHSN) risk model for sternal, deep incisional, and organ/space (complex) surgical site infections (SSIs) following coronary artery bypass graft (CABG) procedures, detected on admission and readmission, consistent with public reporting requirements.
  
  
  METHODS
  A total of 133,503 CABG procedures with 4,008 associated complex SSIs reported by 293 NHSN hospitals in the United States.
  
  
  METHODS
  CABG procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Potential SSI risk factors were identified by univariate analysis. Multivariate analysis with forward stepwise logistic regression modeling was used to develop the new model. The c-index was used to compare the predictive power of the new and NHSN risk index models.
  
  
  RESULTS
  Multivariate analysis independent risk factors included ASA score, procedure duration, female gender, age, and medical school affiliation. The new risk model has significantly improved predictive performance over the NHSN risk index (c-index, 0.62 and 0.56, respectively).
  
  
  CONCLUSIONS
  Traditionally, the NHSN surveillance system has used a risk index to provide procedure-specific risk-stratified SSI rates to hospitals. A new CABG sternal, complex SSI risk model developed by multivariate analysis has improved predictive performance over the traditional NHSN risk index and is being considered for endorsement as a measure for public reporting.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. zbn6@cdc.gov
authors.forename: Sandra I
authors.initials: SI
authors.lastname: Berríos-Torres
authors.forename: Yi
authors.initials: Y
authors.lastname: Mu
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Edwards
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Horan
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D015999:Multivariate Analysis; D020379:Risk Adjustment / Q000592:standards*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*; D014342:Truth Disclosure; D014481:United States / Q000453:epidemiology