title: Surgical site infection: comparing surgeon versus patient self-report.
abstract: BACKGROUND
  To compare the rate of surgical site infection (SSI) using surgeon versus patient report.
  
  
  METHODS
  A prospective observational study of surgical patients in four hospitals within one private health-care system was performed. Surgeon report consisted of contacting the surgeon or staff 30 d after procedure to identify infections. Patient report consisted of telephone contact with the patient and confirmation of infections by a trained surgical clinical reviewer.
  
  
  RESULTS
  Between February 2011 and June 2012, there were 2853 surgical procedures that met inclusion criteria. Surgeon-reported SSI rate was significantly lower (2.4%, P value < 0.01) compared with patient self-report (4.3%). The rate was lower across most infection subtypes (1.3% versus 3.0% superficial, 0.3% versus 0.5% organ/space) except deep incisional, most procedure types (2.3% versus 4.4% general surgery) except plastics, most patient characteristics (except body mass index < 18.5), and all hospitals. There were disagreements in 3.4% of cases; 74 cases reported by patients but not surgeons and 21 cases vice versa. Disagreements were more likely in superficial infections (59.8% versus 1.0%), C-sections (22.7% versus 17.7%), hospital A (22.7% versus 17.7%), age < 65 y (74.2% versus 68.3%), and body mass index ≥ 30 (54.2% versus 39.9%).
  
  
  CONCLUSIONS
  Patient report is a more sensitive method of detection of SSI compared with surgeon report, resulting in nearly twice the SSI rate. Fair and consistent ways of identifying SSIs are essential for comparing hospitals and surgeons, locally and nationally.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: jpham3@jhmi.edu.
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
authors.affiliation: Department of Patient Safety and Quality, Hawaii Pacific Health, Honolulu, Hawaii.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Ashton
authors.affiliation: Department of Patient Safety and Quality, Hawaii Pacific Health, Honolulu, Hawaii.
authors.forename: Chieko
authors.initials: C
authors.lastname: Kimata
authors.affiliation: Hawaii Safer Care SUSP, Honolulu, Hawaii.
authors.forename: Della M
authors.initials: DM
authors.lastname: Lin
authors.affiliation: Department of Patient Safety and Quality, Straub Clinic and Hospital, Honolulu, Hawaii; Department of Neurology, Straub Clinic and Hospital, Honolulu, Hawaii.
authors.forename: Beau K
authors.initials: BK
authors.lastname: Nakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D057566:Self Report; D066231:Surgeons; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: Health care–acquired infection; Hospital-acquired condition; National Healthcare Surveillance Network; National surgical quality improvement program; Patient report; Quality improvement; Surgeon report; Surgical site infection; Surveillance