title: Enhanced surgical site infection surveillance following hysterectomy, vascular, and colorectal surgery.
abstract: OBJECTIVE
  To evaluate the use of inpatient pharmacy and administrative data to detect surgical site infections (SSIs) following hysterectomy and colorectal and vascular surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Five hospitals affiliated with academic medical centers.
  
  
  METHODS
  Adults who underwent abdominal or vaginal hysterectomy, colorectal surgery, or vascular surgery procedures between July 1, 2003, and June 30, 2005.
  
  
  METHODS
  We reviewed the medical records of weighted, random samples drawn from 3,079 abdominal and vaginal hysterectomy, 4,748 colorectal surgery, and 3,332 vascular surgery procedures. We compared routine surveillance with screening of inpatient pharmacy data and diagnosis codes and then performed medical record review to confirm SSI status.
  
  
  RESULTS
  Medical records from 823 hysterectomy, 736 colorectal surgery, and 680 vascular surgery procedures were reviewed. SSI rates determined by antimicrobial- and/or diagnosis code-based screening followed by medical record review (enhanced surveillance) were substantially higher than rates determined by routine surveillance (4.3% [95% confidence interval, 3.6%-5.1%] vs 2.7% for hysterectomies, 7.1% [95% confidence interval, 6.7%-8.2%] vs 2.0% for colorectal procedures, and 2.3% [95% confidence interval, 1.9%-2.9%] vs 1.4% for vascular procedures). Enhanced surveillance had substantially higher sensitivity than did routine surveillance to detect SSI (92% vs 59% for hysterectomies, 88% vs 22% for colorectal procedures, and 72% vs 43% for vascular procedures). A review of medical records confirmed SSI for 31% of hysterectomies, 20% of colorectal procedures, and 31% of vascular procedures that met the enhanced screening criteria.
  
  
  CONCLUSIONS
  Antimicrobial- and diagnosis code-based screening may be a useful method for enhancing and streamlining SSI surveillance for a variety of surgical procedures, including those procedures targeted by the Centers for Medicare and Medicaid Services.
authors: Channing Laboratory and Infectious Diseases Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. dyokoe@partners.org
authors: Deborah S
authors: DS
authors: Yokoe
authors: Yosef
authors: Y
authors: Khan
authors: Margaret A
authors: MA
authors: Olsen
authors: David C
authors: DC
authors: Hooper
authors: Maurice
authors: M
authors: Greenbaum
authors: Johanna
authors: J
authors: Vostok
authors: Julie
authors: J
authors: Lankiewicz
authors: Victoria J
authors: VJ
authors: Fraser
authors: Kurt B
authors: KB
authors: Stevenson
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D003108:Colonic Diseases / Q000601:surgery; D016001:Confidence Intervals; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008499:Medical Records; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012002:Rectal Diseases / Q000601:surgery; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014652:Vascular Diseases / Q000601:surgery
chemical_list: D000890:Anti-Infective Agents