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A computerized indicator for surgical site infection (SSI) assessment after total hip or total knee replacement: The French ISO-ORTHO indicator

Published online by Cambridge University Press:  09 September 2021

Leslie Grammatico-Guillon Open the ORCID record for Leslie Grammatico-Guillon [Opens in a new window] ,
Katiuska Miliani ,
Linda Banaei-Bouchareb ,
Agnès Solomiac ,
Jessica Sambour ,
Laetitia May-Michelangeli  and
Pascal Astagneau
Leslie Grammatico-Guillon*
Affiliation:
Service of Public Health, Epidemiology and Data Center, Teaching Hospital of Tours, Tours, France Medical School, University of Tours, Tours, France
Katiuska Miliani
Affiliation:
Centre de prévention des infections associés aux soins (CPIAS), Paris, France
Linda Banaei-Bouchareb
Affiliation:
French National Authority for Health (Haute Autorité de Santé, HAS), Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l’Amélioration de la qualité et de la sécurité des soins, Saint-Denis-La-Plaine, France
Agnès Solomiac
Affiliation:
French National Authority for Health (Haute Autorité de Santé, HAS), Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l’Amélioration de la qualité et de la sécurité des soins, Saint-Denis-La-Plaine, France
Jessica Sambour
Affiliation:
Centre de prévention des infections associés aux soins (CPIAS), Paris, France
Laetitia May-Michelangeli
Affiliation:
French National Authority for Health (Haute Autorité de Santé, HAS), Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l’Amélioration de la qualité et de la sécurité des soins, Saint-Denis-La-Plaine, France
Pascal Astagneau
Affiliation:
Centre de prévention des infections associés aux soins (CPIAS), Paris, France Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
*
Author for correspondence: Dr Leslie Grammatico-Guillon, E-mail: Leslie.guillon@univ-tours.fr
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Abstract

Objective:

The French National Authority for Health (HAS), with a multidisciplinary working group, developed an indicator ‘ISO-ORTHO’ to assess surgical site infections (SSIs) after total hip arthroplasty or total knee arthroplasty (THA/TKA) based on the hospital discharge database. We present the ISO-ORTHO indicator designed for SSI automated detection and its relevance for quality improvement and hospital benchmarks.

Methods:

The algorithm is based on a combination of International Statistical Classification of Diseases, Tenth Revision (ICD-10) and procedure codes of the hospital stay. The target population was selected among adult patients who had a THA or TKA between January 1, 2017, and September 30, 2017. Patients at very high risk of SSI and/or with SSI not related to hospital care were excluded. We searched databases for SSIs up to 3 months after THA/TKA. The standardized infection ratio (SIR) of observed versus expected SSIs was calculated (logistic regression) and displayed as funnel plot with 2 and 3 standard deviations (SD) after adjustment for 13 factors known to increase SSI risk.

Results:

In total, 790 hospitals and 139,926 THA/TKA stays were assessed; 1,253 SSI were detected in the 473 included hospitals (incidence, 0.9%: 1.0% for THA, 0.80% for TKA). The SSI rate was significantly higher in males (1.2%), in patients with previous osteo-articular infection (4.4%), and those with cancer (2.3%), obesity, or diabetes. Most hospitals (89.9%) were within 2 SD; however, 12 hospitals were classified as outliers at more than +3 SD (1.6% of facilities), and 59 hospitals (7.9%) were outliers between +2 SD and +3 SD.

Conclusion:

ISO-ORTHO is a relevant indicator for automated surveillance; it can provide hospitals a metric for SSI assessment that may contribute to improving patient outcomes.

Keywords

surgical site infectionorthopedicsautomated surveillance indicatorhealthcare quality improvement
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1171 - 1178
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

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