title: Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups.
abstract: BACKGROUND
  The National Healthcare Safety Network (NHSN) classifies surgical procedures into 40 categories. The objective of this study was to determine surgical site infection (SSI) incidence for clinically defined subgroups within 5 heterogeneous NHSN surgery categories.
  
  
  METHODS
  This is a retrospective cohort study using the longitudinal State Inpatient Database. We identified 5 groups of surgical procedures (amputation; bile duct, liver or pancreas [BILI]; breast; colon; and hernia) using ICD-9-CM procedure codes in community hospitals in California, Florida, and New York from January 2009-September 2011 in persons aged ≥18 years. Each of these 5 categories was classified to more specific surgical procedures within the group. The 90-day SSI rates were calculated using ICD-9-CM diagnosis codes.
  
  
  RESULTS
  There were 62,901 amputation surgeries, 33,358 BILI surgeries, 72,058 breast surgeries, 125,689 colon surgeries, and 85,745 hernia surgeries in 349,298 people. The 90-day SSI rates varied significantly within each of the 5 subgroups. Within the BILI category, bile duct, pancreas, and laparoscopic liver procedures had SSI rates of 7.2%, 17.2%, and 2.2%, respectively (P < .0001 for each) compared with open liver procedures (11.1% SSI).
  
  
  CONCLUSIONS
  The 90-day SSI rates varied widely within certain NHSN categories. Risk adjustment for specific surgery type is needed to make valid comparisons between hospitals.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO. Electronic address: msaeed@wustl.edu.
authors.forename: Mohammed J
authors.initials: MJ
authors.lastname: Saeed
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects*; D001940:Breast / Q000601:surgery*; D002140:California / Q000453:epidemiology; D019058:Community Networks; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005431:Florida / Q000453:epidemiology; D059685:Herniorrhaphy / Q000009:adverse effects*; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult
keywords: National Healthcare Safety Network; Risk adjustment; Surgical site infection; Surveillance
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