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An Apparent Excess of Operative Site Infections: Analyses to Evaluate False-Positive Diagnoses

Published online by Cambridge University Press:  02 January 2015

N. Joel Ehrenkranz ,
Emily I. Richter ,
Pamela M. Phillips  and
James M. Shultz
N. Joel Ehrenkranz
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Emily I. Richter
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Pamela M. Phillips
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
James M. Shultz
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida University of Miami School of Medicine, South Miami, Florida
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Abstract

Objective:

To investigate an apparent excess of operative site infections (OSI) reported according to doctor's diagnosis (presumptive OSI) by applying objective criteria for classification (documented OSI). To examine potential consequences of habitual overdiagnosis of OSI.

Design:

A case-control design was used to examine the clinical course of 18 case patients (12 presumptive OSI, six documented OSI) and 18 matched controls. Comparisons also were made between presumptive and documented OSI patients.

Setting:

A nonteaching community hospital.

Patients:

Thirty-six patients having laminectomies done by the same surgeon.

Intervention:

Implementation of objective criteria for diagnosis of confirmed OSI and reclassification of presumptive OSI patients.

Results:

Postoperatively, the frequency of specific adverse events within the operative site (including post-operative hematoma or bleeding; wound necrosis, dehiscence, or sinus tract; and dural tear) was 83% for documented OSI patients, contrasted with 16.7% for presumptive OSI patients (P<.01) and controls (P=.007). Median days of inpatient stay were 27 for documented OSI, contrasted with 9.5 for presumptive OSI (P=.01) and 7 for controls (P<.001).

Conclusion:

Documented OSI patients were found to have significantly more adverse findings and longer lengths of stay than presumptive OSI patients or controls. The similarity of findings for presumptive OSI patients and controls suggests that the apparent excess frequency of OSI was caused by incorrect diagnosis. Whereas doctor's diagnosis may be useful as an initial screen for OSI, use of objective criteria for confirming OSI may avert the consequences of overdiagnosis, including excessive length of stay and unnecessary therapy, which lead to elevated healthcare costs and threaten a physician's practice.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 12 , December 1995 , pp. 712 - 716
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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