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To develop prognostic models for improved risk adjustment in surgical site infection surveillance for 5 surgical procedures and to compare these models with the National Nosocomial Infection Surveillance system (NNIS) risk index.
In a multicenter cohort study, prospective assessment of surgical site infection and risk factors was performed from 1996 to 2000. In addition, risk factors abstracted from patient files, available in a national medical register, were used. The c-index was used to measure the ability of procedure-specific logistic regression models to predict surgical site infection and to compare these models with models based on the NNIS risk index. A c-index of 0.5 indicates no predictive power, and 1.0 indicates perfect predictive power.
Sixty-two acute care hospitals in the Dutch national surveillance network for nosocomial infections.
Patients who underwent 1 of 5 procedures for which the predictive ability of the NNIS risk index was moderate: reconstruction of the aorta (n = 875), femoropopliteal or femorotibial bypass (n = 641), colectomy (n = 1,142), primarytotal hip prosthesis (n = 13,770), and cesarean section (n = 2,962).
The predictive power of the new model versus the NNIS index was 0.75 versus 0.62 for reconstruction of the aorta (P< .01), 0.78 versus 0.58 for femoropopliteal or femorotibial bypass (P< .001), 0.69 versus 0.62 for colectomy (P< .001), 0.64 versus 0.56 for primary total hip prosthesis arthroplasty (P< .001), and 0.70 versus 0.54 for cesarean section (P< .001).
Data available from hospital information systems can be used to develop models that are better at predicting the risk of surgical site infection than the NNIS risk index. Additional data collection may be indicated for certain procedures–for example, total hip prosthesis arthroplasty.
To determine hospital-related risk factors for surgical-site infection (SSI) following hip arthroplasty.
Prospective, multicenter cohort study based on surveillance data and data collected through a structured telephone interview. With the use of multilevel logistic regression, the independent effect of hospital-related characteristics on SSI was assessed.
Thirty-six acute care hospitals in the Dutch surveillance network for nosocomial infections (PREZIES), from 1996 to 2000.
Thirteen thousand six hundred eighty patients who underwent total or partial hip arthroplasty.
A high annual volume of operations was associated with a reduced risk of SSI (risk-adjusted risk ratio [RR] per 50 extra operations, 0.85; 95% confidence interval [CI95], 0.74–0.97). With each extra full-time–equivalent infection control staff member per 250 beds available for prevention of SSI, the risk for SSI was decreased (RR, 0.48; CI95, 0.16–1.44), although the decrease was not statistically significant. Hospital size, teaching status, university affiliation, and number of surgeons and their years of experience showed no important association with the risk of SSI.
Undergoing surgery in a hospital with a low volume of operations increases a patient's risk of SSI.
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