title: Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
abstract: BACKGROUND
  Surgical site infections (SSIs) following vascular surgery have high morbidity and costs, and are increasingly tracked as hospital quality measures.
  
  
  OBJECTIVE
  To assess the ability of Medicare claims to identify US hospitals with high SSI rates after vascular surgery.
  
  
  METHODS
  Using claims from fee-for-service Medicare enrollees of age 65 years and older who underwent vascular surgery from 2005 to 2008, we derived hospital rankings using previously validated codes suggestive of SSI, with individual-level adjustment for age, sex, and comorbidities. We then obtained medical records for validation of SSI from hospitals ranked in the best and worst deciles of performance, and used logistic regression to calculate the risk-adjusted odds of developing an SSI in worst-decile versus best-decile hospitals.
  
  
  RESULTS
  Among 203,023 Medicare patients who underwent vascular surgery at 2512 US hospitals, a patient undergoing surgery in a hospital ranked in the worst-performing decile based on claims had 2.5 times higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.0-3.1). SSI confirmation among patients with claims suggesting infection was similar across deciles, and we found similar findings in analyses limited to deep and organ/space SSIs. We report on diagnosis codes with high sensitivity for identifying deep and organ/space SSI, with one-to-one mapping to ICD-10-CM codes.
  
  
  CONCLUSIONS
  Claims-based surveillance offers a standardized and objective methodology that can be used to improve SSI surveillance and to validate hospitals' publicly reported data.
authors.affiliation: *Division of Infectious Diseases, Brigham and Women's Hospital †Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA ‡University of Oklahoma Health Sciences Center, College of Public Health §Oklahoma Foundation for Medical Quality, Oklahoma City, OK ∥Division of Infectious Diseases, Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Calderwood
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Allen
authors.initials: A
authors.lastname: Ma
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Kaganov
authors.forename: Christina B
authors.initials: CB
authors.lastname: Bruce
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Balaconis
authors.forename: Claire
authors.initials: C
authors.lastname: Canning
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; D019985:Benchmarking / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D006278:Medicare / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*