title: Patient Self-Assessment of Surgical Site Infection is Inaccurate.
abstract: Availability of surgical site infection (SSI) surveillance rates challenges clinicians, healthcare administrators and leaders and the public. The purpose of this report is to demonstrate the consequences patient self-assessment strategies have on SSI reporting rates.
  
  
  
  We performed SSI surveillance among patients undergoing general surgery procedures, including telephone follow-up 30 days after surgery. Additionally we undertook a separate validation study in which we compared patient self-assessments of SSI with surgeon assessment. Finally, we performed a meta-analysis of similar validation studies of patient self-assessment strategies.
  
  
  
  There were 22/266 in-hospital SSIs diagnosed (8.3%), and additional 16 cases were detected through the 30-day follow-up. In total, the SSI rate was 16.8% (95% CI 10.1-18.5). In the validation survey, we found patient telephone surveillance to have a sensitivity of 66% (95% CI 40-93%) and a specificity of 90% (95% CI 86-94%). The meta-analysis included five additional studies. The overall sensitivity was 83.3% (95% CI 79-88%), and the overall specificity was 97.4% (95% CI 97-98%). Simulation of the meta-analysis results divulged that when the true infection rate is 1%, reported rates would be 4%; a true rate of 50%, the reported rates would be 43%.
  
  
  
  Patient self-assessment strategies in order to fulfill 30-day SSI surveillance misestimate SSI rates and lead to an erroneous overall appreciation of inter-institutional variation. Self-assessment strategies overestimate SSIs rate of institutions with high-quality performance and underestimate rates of poor performance. We propose such strategies be abandoned. Alternative strategies of patient follow-up strategies should be evaluated in order to provide valid and reliable information regarding institutional performance in preventing patient harm.
authors.affiliation: Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Vered
authors.initials: V
authors.lastname: Richter
authors.affiliation: Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel. Matanc123@gmail.com.|Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Matanc123@gmail.com.
authors.forename: Matan J
authors.initials: MJ
authors.lastname: Cohen
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Benenson
authors.affiliation: Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Almogy
authors.affiliation: Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Mayer
authors.initials: M
authors.lastname: Brezis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012647:Self-Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult