Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance?
BACKGROUND
The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated.


METHODS
The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI.


RESULTS
In total, 27,376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8% of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification.


CONCLUSIONS
Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Paul J
PJ
Speicher
Daniel P
DP
Nussbaum
John E
JE
Scarborough
Sabino
S
Zani
Rebekah R
RR
White
Dan G
DG
Blazer
Christopher R
CR
Mantyh
Douglas S
DS
Tyler
Bryan M
BM
Clary
D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000592:standards; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006498:Hepatectomy / Q000009:adverse effects* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects* / Q000592:standards; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000592:standards; D010465:Perception; D017410:Practice Guidelines as Topic; D011639:Public Opinion; D019984:Quality Indicators, Health Care / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000145:classification* / Q000175:diagnosis / Q000382:microbiology; D009626:Terminology as Topic; D016896:Treatment Outcome; D014481:United States