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National validation of the Centers for Medicare & Medicaid Services strategy for identifying potential surgical-site infections following colon surgery and abdominal hysterectomy

Published online by Cambridge University Press:  07 September 2023

Michael S. Calderwood Open the ORCID record for Michael S. Calderwood [Opens in a new window] ,
Ken Kleinman ,
Christina B. Bruce Open the ORCID record for Christina B. Bruce [Opens in a new window] ,
Lauren Shimelman ,
Rebecca E. Kaganov ,
Richard Platt  and
Susan S. Huang Open the ORCID record for Susan S. Huang [Opens in a new window]
Michael S. Calderwood*
Affiliation:
Section of Infectious Disease and International Health, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
Ken Kleinman
Affiliation:
University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts, USA
Christina B. Bruce
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
Lauren Shimelman
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
Rebecca E. Kaganov
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
Susan S. Huang
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
*
Corresponding author: Michael S. Calderwood; Email: Michael.S.Calderwood@hitchcock.org
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Abstract

Objective:

National validation of claims-based surveillance for surgical-site infections (SSIs) following colon surgery and abdominal hysterectomy.

Design:

Retrospective cohort study.

Setting:

US hospitals selected for data validation by Centers for Medicare & Medicaid Services (CMS).

Participants:

The study included 550 hospitals performing colon surgery and 458 hospitals performing abdominal hysterectomy in federal fiscal year 2013.

Methods:

We requested 1,200 medical records from hospitals selected for validation as part of the CMS Hospital Inpatient Quality Reporting program. For colon surgery, we sampled 60% with a billing code suggestive of SSI during their index admission and/or readmission within 30 days and 40% who were readmitted without one of these codes. For abdominal hysterectomy, we included all patients with an SSI code during their index admission, all patients readmitted within 30 days, and a sample of those with a prolonged surgical admission (length of stay > 7 days). We calculated sensitivity and positive predictive value for the different groups.

Results:

We identified 142 colon-surgery SSIs (46 superficial SSIs and 96 deep and organ-space SSIs) and 127 abdominal-hysterectomy SSIs (58 superficial SSIs and 69 deep and organ-space SSIs). Extrapolating to the full CMS data validation cohort, we estimated an SSI rate of 8.3% for colon surgery and 3.0% for abdominal hysterectomy. Our colon-surgery surveillance codes identified 93% of SSIs, with 1 SSI identified for every 2.6 patients reviewed. Our abdominal-hysterectomy surveillance codes identified 73% of SSIs, with 1 SSI identified for every 1.6 patients reviewed.

Conclusions:

Using claims to target record review for SSI validation performed well in a national sample.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 2 , February 2024 , pp. 167 - 173
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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