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Interhospital Comparison of Surgical Site Infection Rates in Orthopedic Surgery

Published online by Cambridge University Press:  31 January 2017

Jozica Skufca ,
Jukka Ollgren ,
Mikko J. Virtanen ,
Kaisa Huotari  and
Outi Lyytikäinen
Jozica Skufca*
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
Jukka Ollgren
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
Mikko J. Virtanen
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
Kaisa Huotari
Affiliation:
Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Outi Lyytikäinen
Affiliation:
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
*
Address correspondence to Jozica Skufca, DVM, National Institute for Health and Welfare (THL), Mannerheimintie 166, PO Box 30, FI-00271 Helsinki, Finland ([email protected]).
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Abstract

OBJECTIVE

To investigate whether comparison by deep or adjusted deep surgical site infection (SSI) rates in orthopedic surgeries are a better basis for feedback to Finnish hospitals than overall SSI rates

DESIGN

Retrospective cohort study

SETTING

Hospitals conducting surveillance of hip arthroplasties (HPROs) and knee arthroplasties (KPROs) in the Finnish Hospital Infection Program

METHODS

We analyzed surveillance data for 73,227 HPROs and 56,860 KPROs performed in 18 hospitals during 1999–2014. For each hospital, the overall, deep, and adjusted deep SSI rates with 95% confidence intervals (CIs) were calculated, and the hospital ranks were simulated in the Bayesian framework. Adjustments were performed using relevant patient and hospital characteristics. The correlation between the median expected hospital ranks in overall versus deep SSI rates and deep vs adjusted deep SSI rates were assessed using Spearman’s correlation coefficient ρ.

RESULTS

For HPRO, the overall SSI rates ranged from 0.92 to 6.83, the deep SSI rates ranged from 0.34 to 1.86, and the adjusted deep hospital-specific SSI rates ranged from 0.37 to 1.85. For KPRO, the overall SSI rates ranged from 0.71 to 5.03, the deep SSI rates ranged from 0.42 to 1.60, and the adjusted deep hospital-specific SSI rates ranged from 0.56 to 1.55. For both procedures, the 95% CIs of the rates between hospitals largely overlapped; only single outliers were detected. Hospital rank did not correlate between overall and deep SSI rates (HPRO, ρ=0.03; KPRO, ρ=0.40), but a correlation was observed in hospital rank for deep and adjusted deep SSI rates (HPRO, ρ=0.85; KPRO, ρ=0.94).

CONCLUSION

Deep SSI rates may be a better tool for interhospital comparisons than overall SSI rates. Although the adjustment could lead to fairer hospital ranking, it is not always necessary for feedback.

Infect Control Hosp Epidemiol 2017;38:423–429

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 4 , April 2017 , pp. 423 - 429
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: The data from this study were presented in part as a poster presentation at the 2016 European Scientific Conference on Applied Infectious Disease Epidemiology, Stockholm, Sweden, on November 28, 2016.

References

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