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Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safely Network

  • Yi Mu (a1), Jonathan R. Edwards (a1), Teresa C. Horan (a1), Sandra I. Berrios-Torres (a1) and Scott K. Fridkin (a1)...
Abstract
Background.

The National Healthcare Safety Network (NHSN) has provided simple risk adjustment of surgical site infection (SSI) rates to participating hospitals to facilitate quality improvement activities; improved risk models were developed and evaluated.

Methods.

Data reported to the NHSN for all operative procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Only SSIs related to the primary incision site were included. A common set of patient- and hospital-specific variables were evaluated as potential SSI risk factors by univariate analysis. Some ific variables were available for inclusion. Stepwise logistic regression was used to develop the specific risk models by procedure category. Bootstrap resampling was used to validate the models, and the c-index was used to compare the predictive power of new procedure-specific risk models with that of the models with the NHSN risk index as the only variable (NHSN risk index model).

Results.

From January 1, 2006, through December 31, 2008, 847 hospitals in 43 states reported a total of 849,659 procedures and 16,147 primary incisional SSIs (risk, 1.90%) among 39 operative procedure categories. Overall, the median c-index of the new procedure-specific risk was greater (0.67 [range, 0.59–0.85]) than the median c-index of the NHSN risk index models (0.60 [range, 0.51–0.77]); for 33 of 39 procedures, the new procedure-specific models yielded a higher c-index than did the NHSN risk index models.

Conclusions.

A set of new risk models developed using existing data elements collected through the NHSN improves predictive performance, compared with the traditional NHSN risk index stratification.

Copyright
Corresponding author
1600 Clifton Road NE MS A-24, Atlanta, GA 30329-4018 (hrb3@cdc.gov)
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5. R Gaynes , C Richards , JR Edwards , et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295298.

6. C Brandt , S Hansen , D Sohr , F Daschner , H Ruden , P Gastmeier . Finding a method for optimizing risk adjustment when comparing surgical-site infecions rates. Infect Control Hosp Epidemiol 2004;25:1318.

8. DH Culver , TC Horan , RP Gaynes , et al. Surgical wound-infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91:S152S157.

12. DM Shahian , SM O'Brien , G Filardo , VA Ferraris , CK Haan , JB Rich , et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Ann Thome Surg 2009;88:S2S22.

14. M Paul , A Raz , L Leibovici , H Madar , R Holinger , B Rubinovitch . Sternal wound infection after coronary artery bypass graft surgery: validation of existing risk scores. J Thorac Cardiovasc Surg 2007;133:397403.

16. JR Edwards , KD Peterson , Y Mu , et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37: 783805.

20. JA Hanley , BJ McNeil . The meaning and use of the area under a receive operating characteristic (ROC) curve. Radiology 1982; 143:2936.

21. JA Hanley , BJ McNeil . A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839843.

22. CS Abboud , SB Wey , VT Baltar . Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 2004;77:676683.

24. RP Gaynes . Surgical-site infections (SSI) and the NNIS SSI risk index, part II: room for improvement. Infect Control Hosp Epidemiol 2001;22:268272.

28. M Kivi , J Mannien , JC Wille , S van den Hof . Surgical site infection surveillance and the predictive power of the National Nosocomial Infection Surveillance index as compared with alternative determinants in the Netherlands. Am J Infect Control 2008;36:S27S31.

29. L Neumayer , P Hosokawa , K Itani , M El-Tamer , WG Henderson , SF Khuri . Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204: 11781187.

30. MA Olsen , P Lock-Buckley , D Hopkins , LB Polish , TM Sundt , VJ Fraser . The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002;124:136145.

32. TS Tran , S Jamulitrat , V Chongsurvivatwong , A Geater . Risk factors for postcesarean surgical site infection. Obstet Gynecol 2000;95:367371.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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