Skip to main content Accessibility help
×
Home
Hostname: page-component-768dbb666b-l8xdn Total loading time: 0.302 Render date: 2023-02-05T23:12:31.362Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

External Validation of the National Healthcare Safety Network Risk Models for Surgical Site Infections in Total Hip and Knee Replacements

Published online by Cambridge University Press:  10 May 2016

Laura W. Lewallen
Affiliation:
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
Hilal Maradit Kremers*
Affiliation:
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
Brian D. Lahr
Affiliation:
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
Tad M. Mabry
Affiliation:
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
James M. Steckelberg
Affiliation:
Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Daniel J. Berry
Affiliation:
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
Arlen D. Hanssen
Affiliation:
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
Elie F. Berbari
Affiliation:
Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Douglas R. Osmon
Affiliation:
Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
*
Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (maradit@mayo.edu).

Abstract

Background.

The National Healthcare Safety Network surgical site infections risk models for hip (HPRO) and knee (KPRO) replacement are intended for case-mix adjustment when reporting surgical site infection rates across institutions, but they are not validated in external data sets

Objective.

To evaluate the validity of HPRO and KPRO risk models and improvement in risk prediction with inclusion of information on morbid obesity and diabetes mellitus.

Design.

Retrospective cohort study.

Patients.

A single-center cohort of 21,941 hip and knee replacement procedures performed between 2002 and 2009.

Methods.

Discriminative ability was assessed using the concordance statistic (C statistic). Calibration was assessed using the Hosmer-Lemeshow goodness-of-fit tests.

Results.

The discrimination of HPRO was good, with a C statistic of 0.695 for surgical site infections and 0.749 for prosthetic joint infections. The discrimination of KPRO was worse than that of HPRO, with a C statistic of 0.592 for surgical site infections and 0.675 for prosthetic joint infections. Adding morbid obesity and diabetes mellitus to the HPRO and KPRO risk models modestly improved discrimination. There was no significant evidence of miscalibration based on the Hosmer-Lemeshow tests, but calibration of HPRO models appeared to be better than that of the KPRO models.

Conclusions.

HPRO performed better than the KPRO in predicting surgical site infections after hip and knee replacements. Both fared well in predicting prosthetic joint infections.

Infect Control Hosp Epidemiol 2014;35(11):1323–1329

Type
Original Article
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Steiner, C, Andrews, R, Barrett, M, Weiss, A. Healthcare Cost and Utilization Project Projections: Mobility/Orthopedic Procedures 2011 to 2012. Rockville, MD: US Agency for Healthcare Research and Quality, 2012. Report 2012–3.Google Scholar
2. Kurtz, SM, Lau, E, Ong, K, Zhao, K, Kelly, M, Bozic, KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009;467(10):26062612.CrossRefGoogle ScholarPubMed
3. Mahomed, NN, Barrett, JA, Katz, JN, et al. Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Joint Surg Am 2003;85-A(1):2732.CrossRefGoogle ScholarPubMed
4. Berbari, EF, Osmon, DR, Lahr, B, et al. The Mayo prosthetic joint infection risk score: implication for surgical site infection reporting and risk stratification. Infect Control Hosp Epidemiol 2012;33(8):774781.CrossRefGoogle ScholarPubMed
5. Bozic, KJ, Ong, K, Lau, E, et al. Estimating risk in Medicare patients with THA: an electronic risk calculator for periprosthetic joint infection and mortality. Clin Orthop Relat Res 2013;471(2):574583.CrossRefGoogle ScholarPubMed
6. Calderwood, MS, Kleinman, K, Bratzler, DW, et al. Use of Medicare claims to identify US hospitals with a high rate of surgical site infection after hip arthroplasty. Infect Control Hosp Epidemiol 2013;34(1):3139.CrossRefGoogle ScholarPubMed
7. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32(10):970986.CrossRefGoogle ScholarPubMed
8. Osmon, DR, Berbari, EF, Berendt, AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56(1):e1e25.CrossRefGoogle ScholarPubMed
9. Delong, ER, Delong, DM, Clarkepearson, DI. Comparing the areas under 2 or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44(3):837845.CrossRefGoogle ScholarPubMed
10. Steyerberg, EW, Vickers, AJ, Cook, NR, et al. Assessing the performance of prediction models a framework for traditional and novel measures. Epidemiology 2010;21(1):128138.CrossRefGoogle ScholarPubMed
11. Vergouwe, Y, Moons, KGM, Steyerberg, EW. External validity of risk models: use of benchmark values to disentangle a case-mix effect from incorrect coefficients. Am J Epidemiol 2010;172(8):971980.CrossRefGoogle ScholarPubMed
12. Fehring, TK, Odum, SM, Griffin, WL, Mason, JB, McCoy, TH. The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty 2007;22(6 suppl 2):7176.CrossRefGoogle ScholarPubMed
13. Marchant, MH Jr, Viens, NA, Cook, C, Vail, TP, Bolognesi, MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 2009;91(7):16211629.CrossRefGoogle ScholarPubMed
14. Bozic, KJ, Ward, DT, Lau, EC, et al. Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a case control study. J Arthroplasty 2014;29(1):154156.CrossRefGoogle ScholarPubMed
7
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

External Validation of the National Healthcare Safety Network Risk Models for Surgical Site Infections in Total Hip and Knee Replacements
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

External Validation of the National Healthcare Safety Network Risk Models for Surgical Site Infections in Total Hip and Knee Replacements
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

External Validation of the National Healthcare Safety Network Risk Models for Surgical Site Infections in Total Hip and Knee Replacements
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *