title: Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery.
abstract: OBJECTIVE
  Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system.
  
  
  METHODS
  This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS).
  
  
  RESULTS
  One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI.
  
  
  CONCLUSIONS
  Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method.
authors.affiliation: Neurosurgery department, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34091 Montpellier cedex 05, France. Electronic address: julienboetto@yahoo.fr.
authors.forename: J
authors.initials: J
authors.lastname: Boetto
authors.affiliation: Neurosurgery department, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34091 Montpellier cedex 05, France.
authors.forename: E
authors.initials: E
authors.lastname: Chan-Seng
authors.affiliation: Orthopaedic department, Raymond-Poincaré hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
authors.forename: G
authors.initials: G
authors.lastname: Lonjon
authors.affiliation: Information Medical Department, Montpellier University Hospital, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France.
authors.forename: J
authors.initials: J
authors.lastname: Pech
authors.affiliation: Infection Control Department, Montpellier University Hospital, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France.
authors.forename: A
authors.initials: A
authors.lastname: Lotthé
authors.affiliation: Neurosurgery department, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34091 Montpellier cedex 05, France.
authors.forename: N
authors.initials: N
authors.lastname: Lonjon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D006751:Hospital Information Systems / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011446:Prospective Studies; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult
keywords: Prospective surveillance; Risk factors; Spine; Surgical site infection