TY - JOUR
T1 - Improved surveillance for surgical site infections after orthopedic implantation procedures
T2 - Extending applications for automated data
AU - Bolon, Maureen K.
AU - Hooper, David
AU - Stevenson, Kurt B.
AU - Greenbaum, Maurice
AU - Olsen, Margaret A.
AU - Herwaldt, Loreen
AU - Noskin, Gary A.
AU - Fraser, Victoria J.
AU - Climo, Michael
AU - Khan, Yosef
AU - Vostok, Johanna
AU - Yokoe, Deborah S.
N1 - Funding Information:
We conducted 2 parallel studies at 8 hospitals affiliated with 6 CDC Prevention Epicenters that evaluate the use of quantitative antimicrobial exposure and diagnosis codes to detect SSIs after THA and TKA procedures. The CDC Prevention Epicenters are a collaborative research network funded by the CDC. The same study design was used for evaluation of both surgical procedures. The study received institutional review board approval at each study site. Because of institutional review board restrictions, 1 institution excluded cases that occurred in prisoners.
PY - 2009/5/1
Y1 - 2009/5/1
N2 - Background. Screening methods that use automated data may streamline surgical site infection (SSI) surveillance and improve the accuracy and comparability of data on SSIs. We evaluated the use of automated inpatient diagnosis codes and pharmacy data to identify SSIs after arthroplasty. Methods. This retrospective cohort study at 8 hospitals involved weighted, random samples of medical records from 2128 total hip arthroplasty (THA) procedures performed from 1 July 2002 through 30 June 2004, and 4194 total knee arthroplasty (TKA) procedures performed from 1 July 2003 through 30 June 2005. We compared routine surveillance with screening of inpatient pharmacy data and diagnoses codes followed by medical record review to confirm SSI status. Results. Records from 696 THA and 1009 TKA procedures were reviewed. The SSI rates were nearly double those determined by routine surveillance (1.32% [95% confidence interval, 0.83%-1.81%] vs. 0.75% for THA; 1.83% [95% confidence interval, 1.43%-2.23%] vs. 0.71% for TKA). An inpatient diagnosis code for infection within a year after the operation had substantially higher sensitivity (THA, 89%; TKA, 81%), compared with routine surveillance (THA, 56%; TKA, 39%). Adding antimicrobial exposure of 5=7 days after the procedure increased the sensitivity (THA, 93%; TKA, 86%). Record review confirmed SSIs after 51% of THAs and 55% of TKAs that met diagnosis code criteria and after 25% of THAs and 39% of TKAs that met antimicrobial exposure and/or diagnosis code criteria. Conclusions. Focused surveillance among a subset of patients who met diagnosis code screening criteria with or without the addition of antimicrobial exposure-based screening was more sensitive than routine surveillance for detecting SSIs after arthroplasty and could be an efficient and readily standardized adjunct to traditional methods.
AB - Background. Screening methods that use automated data may streamline surgical site infection (SSI) surveillance and improve the accuracy and comparability of data on SSIs. We evaluated the use of automated inpatient diagnosis codes and pharmacy data to identify SSIs after arthroplasty. Methods. This retrospective cohort study at 8 hospitals involved weighted, random samples of medical records from 2128 total hip arthroplasty (THA) procedures performed from 1 July 2002 through 30 June 2004, and 4194 total knee arthroplasty (TKA) procedures performed from 1 July 2003 through 30 June 2005. We compared routine surveillance with screening of inpatient pharmacy data and diagnoses codes followed by medical record review to confirm SSI status. Results. Records from 696 THA and 1009 TKA procedures were reviewed. The SSI rates were nearly double those determined by routine surveillance (1.32% [95% confidence interval, 0.83%-1.81%] vs. 0.75% for THA; 1.83% [95% confidence interval, 1.43%-2.23%] vs. 0.71% for TKA). An inpatient diagnosis code for infection within a year after the operation had substantially higher sensitivity (THA, 89%; TKA, 81%), compared with routine surveillance (THA, 56%; TKA, 39%). Adding antimicrobial exposure of 5=7 days after the procedure increased the sensitivity (THA, 93%; TKA, 86%). Record review confirmed SSIs after 51% of THAs and 55% of TKAs that met diagnosis code criteria and after 25% of THAs and 39% of TKAs that met antimicrobial exposure and/or diagnosis code criteria. Conclusions. Focused surveillance among a subset of patients who met diagnosis code screening criteria with or without the addition of antimicrobial exposure-based screening was more sensitive than routine surveillance for detecting SSIs after arthroplasty and could be an efficient and readily standardized adjunct to traditional methods.
UR - http://www.scopus.com/inward/record.url?scp=65549085694&partnerID=8YFLogxK
U2 - 10.1086/597584
DO - 10.1086/597584
M3 - Article
C2 - 19335165
AN - SCOPUS:65549085694
SN - 1058-4838
VL - 48
SP - 1223
EP - 1229
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 9
ER -