Enhanced identification of postoperative infections among outpatients

Andrew L Miner, Kenneth E Sands, Deborah S Yokoe, John Freedman, Kristin Thompson, James M Livingston, Richard Platt, Andrew L Miner, Kenneth E Sands, Deborah S Yokoe, John Freedman, Kristin Thompson, James M Livingston, Richard Platt

Abstract

We investigated using administrative claims data to identify surgical site infections (SSI) after breast surgery and cesarean section. Postoperative diagnosis codes, procedure codes, and pharmacy information were automatically scanned and used to identify claims suggestive of SSI ("indicators") among 426 (22%) of 1,943 breast procedures and 474 (10%) of 4,859 cesarean sections. For 104 breast procedures with indicators explained in available medical records, SSI were confirmed for 37%, and some infection criteria were present for another 27%. Among 204 cesarean sections, SSI were confirmed for 40%, and some criteria were met for 27%. The extrapolated infection rates of 2.8% for breast procedures and 3.1% for cesarean section were similar to those reported by the National Nosocomial Infection Surveillance program but differ in representing predominantly outpatient infections. Claims data may complement other data sources for identification of surgical site infections following breast surgery and cesarean section.

Figures

Figure 1
Figure 1
Infectious outcomes by predicted probability of surgical site infections (SSI) calculated from SSI indicators for A) breast procedures and B) cesarean sections. Shown are all procedures with adequate documentation, which excludes 80%–90% of procedures with no SSI indicator and predicted probability of infection at baseline, 0.006. Predicted probability of infection is based on the categories of SSI indicators found in claims and pharmacy records. The infectious outcomes for breast procedures are based on postoperative days 0–60; cesarean section outcomes are from days 0–30.
Figure 2
Figure 2
Infectious outcomes among four categories of breast procedure. Each bar represents all procedures with predicted probability of infection >0.03. Shown are 60-day outcomes extrapolated from the rates among procedures with adequate records. p, predicted probability of infection; SSI, surgical site infection; limited, reduction mammoplasty, mastopexy without implant, and mastectomy without axillary dissection or reconstruction; implant, breast procedures with an implant; axillary, breast procedures with axillary dissection; reconstruction, breast procedures with reconstruction.
Figure 3
Figure 3
Hospital-specific infectious outcomes among cesarean sections with surgical site infection (SSI) indicators. Each bar represents all deliveries with potential SSI (n = 10–50), with outcomes extrapolated from those for whom adequate records were returned. Below each bar is the odds ratio (95% confidence interval) for a delivery having an SSI indicator at each hospital, adjusted for age, claims system, and 6-month interval. Hospital A (reference), hospital B (OR 1.2 [95% CI 0.7–2.1]), hospital C (OR 1.7 [95% CI 1.0–2.9]), hospital D (OR 1.8 [95% CI 1.1–2.9]), hospital E (OR 1.7 [95% CI 1.0–2.8], hospital F (OR 1.7 [95% CI 0.9–3.1], hospital G (OR 2.3 [95% CI 1.3–4.0). NNIS, National Nosocomial Infections Surveillance; CI, confidence interval.

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Source: PubMed

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