Improving public reporting and data validation for complex surgical site infections after coronary artery bypass graft surgery and hip arthroplasty.
BACKGROUND
Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data.


METHODS
We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination.


RESULTS
Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code.


CONCLUSIONS
This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation.
Division of Infectious Diseases , Brigham and Women's Hospital , Boston, Massachusetts ; Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
Michael S
MS
Calderwood
Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
Ken
K
Kleinman
Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
Michael V
MV
Murphy
Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
Richard
R
Platt
Division of Infectious Diseases and Health Policy Research Institute , University of California Irvine School of Medicine.
Susan S
SS
Huang
coronary artery bypass graft surgery; hip arthroplasty; infection prevention and control programs; surgical site infection; surveillance and public reporting