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A comparison of surgical site infections following total hip replacement and total knee replacement surgeries identified by Infection Prevention and Control and the National Surgical Quality Improvement Program in Alberta, Canada

Published online by Cambridge University Press:  24 May 2021

Jennifer J. R. Ellison*
Affiliation:
Infection Prevention and Control, Alberta Health Services, Lethbridge, Alberta, Canada
Lesia R. Boychuk
Affiliation:
Infection Prevention and Control, Covenant Health, Edmonton, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
David Chakravorty
Affiliation:
Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
A. Uma Chandran
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Infection Prevention and Control, Alberta Health Services, Edmonton, Alberta, Canada
John M. Conly
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
Andrea Howatt
Affiliation:
Infection Prevention and Control, Covenant Health, Edmonton, Alberta, Canada
Joseph Kim
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
Stacey Litvinchuk
Affiliation:
Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
Arun Pokhrel
Affiliation:
System Performance and Innovation, EMS, Alberta Health Services, Calgary, Alberta, Canada
Ye Shen
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
Christopher Smith
Affiliation:
Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
Kathryn Bush
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
*
Author for correspondence: Jennifer J. R. Ellison, E-mail: jennifer.ellison@ahs.ca

Abstract

Objective:

To understand how the different data collections methods of the Alberta Health Services Infection Prevention and Control Program (IPC) and the National Surgical Quality Improvement Program (NSQIP) are affecting reported rates of surgical site infections (SSIs) following total hip replacements (THRs) and total knee replacements (TKRs).

Design:

Retrospective cohort study.

Setting:

Four hospitals in Alberta, Canada.

Patients:

Those with THR or TKR surgeries between September 1, 2015, and March 31, 2018.

Methods:

Demographic information, complex SSIs reported by IPC and NSQIP were compared and then IPC and NSQIP data were matched with percent agreement and Cohen’s κ calculated. Statistical analysis was performed for age, gender and complex SSIs. A P value <.05 was considered significant.

Results:

In total, 7,549 IPC and 2,037 NSQIP patients were compared. The complex SSI rate for NSQIP was higher compared to IPC (THR: 1.19 vs 0.68 [P = .147]; TKR: 0.92 vs 0.80 [P = .682]). After matching, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC, and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.0; κ = 0.48).

Conclusions:

Different approaches to monitor SSIs may lead to different results and trending patterns. NSQIP reports total SSI rates that are consistently higher than IPC. If systems are compared at any point in time, confidence on the data may be eroded. Stakeholders need to be aware of these variations and education provided to facilitate an understanding of differences and a consistent approach to SSI surveillance monitoring over time.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. Part of these data were presented as an abstract at the Sixth Decennial International Conference on Healthcare-Associated Infections, March 2020, held virtually (abstract published in ICHE 2020;41 suppl 1).

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