Harnessing Claims to Improve Detection of Surgical Site Infections following Hysterectomy and Colorectal Surgery

Abstract

Surgical site infection (SSI) surveillance is performed using a variety of methods with unclear performance characteristics. We used claims data to identify records for review following hysterectomy and colorectal surgery. Claims-enhanced screening identified SSIs missed by routine surveillance and could be used for targeted chart review to improve SSI detection.

Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures

“…The reduced sensitivity to identify non-serious SSIs should not have had significant impact on the calculation of costs attributable to serious infections, since serious SSIs treated in the outpatient setting would be more likely to be coded due to reimbursement of wound care procedures (even in the global reimbursement period), and the sensitivity and positive predictive values of the ICD-9-CM diagnosis codes we used to identify SSIs diagnosed and treated during inpatient hospitalizations are relatively high. 29–31 We adjusted for many factors related to both SSI and medical costs in the quantile regression models, but there may still be residual confounding due to omitted variables (i.e., endogeneity). Although the claims database is large and geographically dispersed all patients have private insurance and our findings may not be generalizable to patients with other types of insurance in the US or in other countries.…”

Impact of the 2012 Medicaid Health Care–Acquired Conditions Policy on Catheter-Associated Urinary Tract Infection and Vascular Catheter–Associated Infection Billing Rates

“…We also examined a comparison condition not targeted by the Medicaid policy, surgical site infection (SSI) following abdominal hysterectomy (567.21, 567.22, 567.29, 682.2, 998.31, 998.32, 995.51, 998.59) [7]. We calculated quarterly rates of non-POA infections.…”

Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: The value of a mandatory system, automated data collection, and active postdischarge surveillance

“…Although traditional case-finding by ICPs has been considered the "gold standard" of HAI surveillance, several newer studies show that this is not necessarily the case: computer-aided surveillance may be more time-efficient and superior in case-finding. Many studies have compared traditional surveillance by ICPs with case-finding using surveillance definitions to available data sources such as ICD-9 diagnostic codes and other administrative coding; 78,81,87,89,[177][178][179][180][181] microbiology, laboratory or pharmacy data; [182][183][184][185] or a combination of these 84,137,146,184,[186][187][188][189] . Some have utilized advanced algorithms to detect SSIs and validate these against ICP case-finding.…”

“…177,197,[200][201][202] Automated data collection may be less prone to inter-rater differences and may help alleviate "surveillance fatigue", and thereby ensure more consistent data over time.…”