title: A comparison of 2 surgical site infection monitoring systems.
abstract: OBJECTIVE
  Surgical site infection (SSI) has emerged as the leading publicly reported surgical outcome and is tied to payment determinations. Many hospitals monitor SSIs using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), in addition to mandatory participation (for most states) in the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), which has resulted in duplication of effort and incongruent data.
  
  
  OBJECTIVE
  To identify discrepancies in the implementation of the NHSN and the ACS NSQIP at hospitals that may be affecting the respective SSI rates.
  
  
  METHODS
  A pilot sample of hospitals that participate in both the NHSN and the ACS NSQIP.
  
  
  METHODS
  For each hospital, observed rates and risk-adjusted observed to expected ratios for year 2012 colon SSIs were collected from both programs. The implementation methods of both programs were identified, including telephone interviews with infection preventionists who collect data for the NHSN at each hospital.
  
  
  METHODS
  Collection methods and colon SSI rates for the NHSN at each hospital were compared with those of the ACS NSQIP.
  
  
  RESULTS
  Of 16 hospitals, 11 were teaching hospitals with at least 500 beds. The mean observed colon SSI rates were dissimilar between the 2 programs, 5.7% (range, 2.0%-14.5%) for the NHSN vs 13.5% (range, 4.6%-26.7%) for the ACS NSQIP. The mean difference between the NHSN and the ACS NSQIP was 8.3% (range, 1.6%-18.8%), with the ACS NSQIP rate always higher. The correlation between the observed to expected ratios for the 2 programs was nonsignificant (Pearson product moment correlation, ρ = 0.4465; P = .08). The NHSN collection methods were dissimilar among interviewed hospitals. An SSI managed as an outpatient case would usually be missed under the current NHSN practices.
  
  
  CONCLUSIONS
  Colon SSI rates from the NHSN and the ACS NSQIP cannot be used interchangeably to evaluate hospital performance and determine reimbursement. Hospitals should not use the ACS NSQIP colon SSI rates for the NHSN reports because that would likely result in the hospital being an outlier for performance. It is imperative to reconcile SSI monitoring, develop consistent definitions, and establish one reliable method. The current state hinders hospital improvement efforts by adding unnecessary confusion to the already complex arena of perioperative improvement.
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois2Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, C.
authors.forename: Mila H
authors.initials: MH
authors.lastname: Ju
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois3Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles4Veterans Affairs Greater Los Angeles Healthcare System, Los Angele.
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois5Department of Surgery, Washington University in St Louis, St Louis, Missouri6Olin Business School and Center for Health Policy, Washington University in St Loui.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: Department of Sociology, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania10Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bosk
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois2Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, C.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.affiliation: Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
mesh_terms: D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards*; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D012308:Risk Management; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D014481:United States