Use of Medicare Claims to Identify US Hospitals with a High Rate of Surgical Site Infection after Hip Arthroplasty

2013 ◽  
Vol 34 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Michael S. Calderwood ◽  
Ken Kleinman ◽  
Dale W. Bratzler ◽  
Allen Ma ◽  
Christina B. Bruce ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Hip Arthroplasty ◽  
Mixed Models ◽  
Medical Records ◽  
High Rate ◽  
Fee For Service ◽  
Site Infection ◽  
Medicare Claims ◽  
Medicare Patients ◽  
Potential Outlier

Objective.To assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty.Design.Retrospective cohort study.Setting.Acute care US hospitals.Participants.Fee-for-service Medicare patients 65 years of age and older who underwent hip arthroplasty in US hospitals from 2005 through 2007.Methods.Hospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst- versus best-performing deciles.Results.Among 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7).Conclusions.Medicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI.

scholarly journals Automated Risk Analysis of Surgical Site Infection in Hip Arthroplasty Surgeries

2020 ◽  
Vol 41 (S1) ◽  
pp. s135-s136
Author(s):  
Flávio Souza ◽  
Braulio Couto ◽  
Felipe Leandro Andrade da Conceição ◽  
Gabriel Henrique Silvestre da Silva ◽  
Igor Gonçalves Dias ◽  
...  
Keyword(s):  
Data Collection ◽  
Infection Control ◽  
Surgical Site Infection ◽  
Hip Arthroplasty ◽  
Hospital Infection ◽  
Site Infection ◽  
Weight Decay ◽  
Hospital Infection Control ◽  
Belo Horizonte ◽  
Arthroplasty Surgery

Background: In 7 hospitals in Belo Horizonte, a city with >3,000,000 inhabitants, a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing arthroplasty surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, the MLPs (multilayer perceptron). Methods: Data were collected on SSI by the hospital infection control committees (CCIHs) of the hospitals involved in the research. All data used in the analysis during their routine SSI surveillance procedures were collected. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which used SACIH automated hospital infection control system software to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed: (1) a treatment of the database collected for the use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing and 35% or 25% for validation). The results were compared by measuring AUC (area under the curve; range, 0–1) presented for each of the configurations. Results: Of 1,246 records, 535 were intact for analysis. We obtained the following statistics: the average surgery time was 190 minutes (range, 145–217 minutes); the average age of the patients was 67 years (range, 9–103); the prosthetic implant index was 98.13%; the SSI rate was 1.49%, and the death rate was 1.21%. Regarding the prediction power, the maximum prediction power was 0.744. Conclusions: Despite the considerable loss rate of almost 60% of the database samples due to the presence of noise, it was possible to perform relevant sampling for the profile evaluation of hospitals in Belo Horizonte. For the predictive process, some configurations have results that reached 0.744, which indicates the usefulness of the structure for automated SSI monitoring for patients undergoing hip arthroplasty surgery. To optimize data collection and to enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com ), a mobile application was developed.Funding: NoneDisclosures: None

scholarly journals Identification of post-cesarean surgical site infection: nursing consultation

2018 ◽  
Vol 71 (suppl 3) ◽  
pp. 1395-1403
Author(s):  
Marcia Regina Cunha ◽  
Maria Clara Padoveze ◽  
Célia Regina Maganha e Melo ◽  
Lucia Yasuko Izumi Nichiata
Keyword(s):  
Quality Of Service ◽  
Health Status ◽  
Surgical Site Infection ◽  
Medical Records ◽  
Signs And Symptoms ◽  
Site Infection ◽  
Cross Sectional ◽  
Cesarean Deliveries ◽  
The City

ABSTRACT Objective: To describe the profile of women in relation to their living conditions, health status and socio-demographic profile, correlating it with the presence of signs and symptoms suggestive of post-cesarean surgical site infection, identifying information to be considered in the puerperium consultation performed by nurses and proposing a roadmap for the systematization of care. Method: Quantitative, exploratory, descriptive, cross-sectional and retrospective review of medical records of women who had cesarean deliveries in 2014, in the city of São Paulo. Results: 89 medical records were analyzed, 62 of them with incomplete information. In 11, there was at least one of the signs and symptoms suggestive of infection. Conclusion: Given the results of the study, the systematization of puerperal consultation is essential. The roadmap is an instrument that can potentially improve the quality of service and the recording of information.

scholarly journals Inflammatory blood parameters as prognostic factors for surgical site infection after primary hip or knee arthroplasty: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046027
Author(s):  
Petr Domecky ◽  
Anna Rejman Patkova ◽  
Katerina Mala-Ladova ◽  
Josef Maly
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Diagnostic Accuracy ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Blood Parameters ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Site Infection

IntroductionSurgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty.Methods and analysisA systematic review of randomised controlled trials, cross-sectional studies, case–control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings.Ethics and disseminationNo ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal.PROSPERO registration numberCRD42020147925.

scholarly journals The application of evidence-based bundle approach to reduce surgical site infection in geriatric hip fracture patients: A single centre experience

2020 ◽  
Vol 27 (2) ◽  
pp. 133-141
Author(s):  
Chow Chun Lok ◽  
Chan Pak Hin Alexander ◽  
Hung Yuk Wah ◽  
Fan Jason Chi Ho
Keyword(s):  
Hip Fracture ◽  
Surgical Site Infection ◽  
Prophylactic Antibiotic ◽  
Length Of Hospital Stay ◽  
High Rate ◽  
Adhesive Tape ◽  
Site Infection ◽  
Intervention Programme ◽  
Community Healthcare ◽  
Geriatric Hip Fracture

Introduction: Surgical site infection (SSI) is associated with increased morbidity and mortality, prolongation on length of hospital stay and cost of community healthcare. In 2010 and 2012, our centre experienced an unexpectedly high rate of SSI in geriatric hip fracture patients with hemiarthroplasty done. A multifaceted intervention programme – ‘bundle approach’ – consisting of preoperative microbiological screening, perioperative measures and postoperative wound care was implemented. Method: Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening was implemented. Intravenous vancomycin was given as prophylactic antibiotic of choice in those patients with positive MRSA screening. All patients will be bathed with chlorhexidine lotion 1 day before operation or on the day of operation. Standardized protocol of surgical site disinfection was implemented: a stringent first stage povidone-iodine disinfection, second stage waterproof extremity draping and sterile plastic sheet wrapping of non-surgical region and third stage ChloraPrep, followed by circumferential iodophor-impregnated plastic adhesive drape (‘Ioban’) covering the hip and thigh region. The surgical wound was dressed with Aquacel adhesive tape after wound closure. Results: The total numbers of infected cases were 17 from 2008 to 2012 and 9 from 2013 to 2018 (first quarter). The rates of infection were 7.02% from 2008 to 2012 and 3.16% from 2013 to 2018 (first quarter). There was a statistically significant reduction in the number of infected cases of hemiarthroplasty after the implementation of bundle approach ( p = 0.0411). Discussion: The bundle approach showed to achieve an effective and sustained decrease in SSI for the geriatric hip fracture patients.

scholarly journals Medicare Claims Can Be Used to Identify US Hospitals With Higher Rates of Surgical Site Infection Following Vascular Surgery

Medical Care ◽  
2014 ◽  
Vol 52 (10) ◽  
pp. 918-925 ◽  
Author(s):  
Michael S. Calderwood ◽  
Ken Kleinman ◽  
Dale W. Bratzler ◽  
Allen Ma ◽  
Rebecca E. Kaganov ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Surgical Site Infection ◽  
Site Infection ◽  
Medicare Claims

scholarly journals Negative pressure wound therapy in the treatment of surgical site infection in cardiac surgery

2020 ◽  
Vol 73 (5) ◽  
Author(s):  
Mayra de Castro Oliveira ◽  
Alessandra Yuri Takehana de Andrade ◽  
Ruth Natalia Teresa Turrini ◽  
Vanessa de Brito Poveda
Keyword(s):  
Cardiac Surgery ◽  
Surgical Site Infection ◽  
Negative Pressure ◽  
Medical Records ◽  
Negative Pressure Wound Therapy ◽  
Myocardial Revascularization ◽  
Site Infection ◽  
Wound Therapy ◽  
Convenience Sample ◽  
Incisional Surgical Site Infection

ABSTRACT Objectives: to describe the relationship between epidemiological and clinical characteristics of postoperative cardiac surgery patients undergoing negative pressure wound therapy for the treatment of surgical site infection. Methods: an observational, cross-sectional analytical study including a convenience sample consisting of medical records of patients undergoing sternal cardiac surgery with surgical site infection diagnosed in medical records treated by negative pressure wound therapy. Results: medical records of 117 patients, mainly submitted to myocardial revascularization surgery and with deep incisional surgical site infection (88; 75.2%). Negative pressure wound therapy was used on mean for 16 (±9.5) days/patient; 1.7% had complications associated with therapy and 53.8% had discomfort, especially pain (93.6%). The duration of therapy was related to the severity of SSI (p=0.010) and the number of exchanges performed (p=0.045). Conclusions: negative pressure wound therapy has few complications, but with discomfort to patients.

Surgical Site Infection Rate after Hemilaminectomy and Laminectomy in Dogs without Perioperative Antibiotic Therapy

2018 ◽  
Vol 31 (03) ◽  
pp. 202-213 ◽  
Author(s):  
Hugo Schmökel ◽  
Barbara Dyall
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Medical Records ◽  
Bacterial Resistance ◽  
Site Infection ◽  
Surgical Wounds ◽  
Superficial Wound ◽  
Single Centre Study ◽  
Perioperative Antibiotics ◽  
Low Incidence

Objective The aim of this study was to retrospectively review the surgical site infection (SSI) rate in dogs undergoing laminectomies without perioperative antibiotics, and compare those data with the expected infection rate for clean surgical wounds in dogs undergoing similar procedures. Methods This was a retrospective single-centre study composed of dogs that underwent hemilaminectomies or laminectomies for thoracolumbar disc herniation or lumbosacral disease during a 2-year period (during 2015 and 2016). All incisional complications within 30 days were recorded and divided into superficial, deep or organ/space infections. Those dogs that received perioperative or postoperative antibiotics due to non-related comorbidities and those with incomplete medical records during the study period were excluded. Results Of 221 consecutive hemilaminectomy and laminectomy procedures, 154 were included in this research study. One superficial wound infection was recorded and treated with antimicrobials. Overall, the SSI rate was 0.6%, while the expected SSI rate in clean operative wounds in dogs and cats is 2.0 to 4.8%. The SSI rate in human spinal surgery is 0.7 to 4.3%. Clinical Significance Considering the low incidence of SSI in our study group, the routine use of perioperative antibiotic prophylaxis in dogs undergoing laminectomy procedures should be reconsidered to help address the global problem of bacterial resistance.

scholarly journals Single-Stage Repair of Contaminated Hernias Using a Novel Antibiotic-Impregnated Biologic Porcine Submucosa Tissue Matrix

2020 ◽  
Author(s):  
samuel fulton minor ◽  
Carl J Brown ◽  
Paul S Rooney ◽  
jason p hodde ◽  
lisa julien ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Single Stage ◽  
High Rate ◽  
Site Infection ◽  
Small Intestine Submucosa ◽  
Biologic Graft ◽  
Device Infection ◽  
Porcine Small Intestine Submucosa ◽  
Tissue Matrix

Abstract Background: Single-stage repair of incisional hernias in contaminated fields has a high rate of surgical site infection (30-42%) when biologic grafts are used for repair. In an attempt to decrease this risk, a novel graft incorporating gentamicin into a biologic extracellular matrix derived from porcine small intestine submucosa was developed. Methods: This prospective, multicenter, single-arm observational study was designed to determine the incidence of surgical site infection following implantation of the device into surgical fields characterized as CDC Class II, III, or IV. Results: Twenty-four patients were enrolled, with 42% contaminated and 25% dirty surgical fields. After 12 months, 5 patients experienced 6 surgical site infections (21%) with infection involving the graft in 2 patients (8%). No grafts were explanted. Conclusions: The incorporation of gentamicin into a porcine-derived biologic graft can be achieved with no noted gentamicin toxicity and a low rate of device infection for patients undergoing single-stage repair of ventral hernia in contaminated settings. Trial Registration: The study was registered March 27, 2015 at www.clinicaltrials.gov as NCT02401334.

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