Use of surgical-site infection rates to rank hospital performance across several types of surgery

Dishoeck, A M van; Koek, M.B.G.; Steyerberg, Ewout W.; Benthem, Birgit H B van; Vos, Margreet C.; Lingsma, Hester F.

doi:10.1002/bjs.9039

Cited by 34 publications

(26 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…27 Numerous studies have also shown variability in riskadjusted patient outcomes across different hospitals and across different procedures, including bariatric surgery. 21,[28][29][30][31] Programs such as the National Surgical Quality Improvement Program have been shown to reduce complication rates at participating hospitals and have proven both cost-effective and cost-saving.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Ontario Bariatric Network: a cohort study

et al. 2016

View full text Add to dashboard Cite

CMAJ OPEN, 4(3) E383O besity remains a growing national and global epidemic. Obesity rates across Canada are estimated to be greater than 20% among adults, 1 with a much higher prevalence of overweight individuals, at 65% and 49% for adult men and women, respectively. Since 1985, rates of obesity have increased 300% while rates of morbid obesity, a body mass index (BMI) greater than 40, have increased fivefold.2 Obesity poses substantial health risks, including cardiac disease, hypertension, diabetes mellitus and, ultimately, premature death. 3,4 In 2006, obesity-related illnesses resulted in an estimated $3.9 billion in direct costs in Canada, with an additional $3.2 billion for indirect costs; these amounts have likely increased over time. 5 Bariatric surgery has been proposed as a treatment for obesity and its associated comorbidities. The surgery has been shown to result in sustainable weight reduction, with longterm data showing patients maintaining 50% or greater loss of excess weight after gastric bypass surgery. [6][7][8] In addition, bariatric surgery, depending on the type of procedure, has a substantial impact on remission and improvement in obesityrelated illnesses. In studies with 2 or more years of follow-up after gastric bypass surgery, 67% of patients diagnosed with diabetes, 38% with hypertension and 60% with hyperlipidemia remained disease-free after surgery; 7 reduced illness severity was attained in additional patients who did not achieve remission.9 Studies have also shown a 50% reduction in mortality after bariatric surgery and an improvement in the quality of life of patients that accompanies their weight loss and improvement in overall health. 10,11The objective of this study was to publish short-term outcomes after bariatric surgery in Canada's largest regional bariatric surgery program, and to compare short-term outcomes between sites. We hypothesize that outcomes of the Ontario Bariatric Network would be similar to other major international centres, with little variation across centres within the program.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of the Ontario Bariatric Network: a cohort study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…17 These data confirm that crude SSI rates do not reliably reflect trends or enable interhospital comparison. 31 For CABG and orthopedic procedures, although our crude SSI rates were similar to adjusted rates for risk index category 1, a large number of patients were classified as risk index category 2, where SSI rates were~50% higher. A crude rate would not adequately convey this increase in risk.…”

Section: Discussionmentioning

confidence: 52%

Diminishing Surgical Site Infections in Australia: Time Trends in Infection Rates, Pathogens and Antimicrobial Resistance Using a Comprehensive Victorian Surveillance Program, 2002–2013

Worth

Bull

Spelman

et al. 2015

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

OBJECTIVETo evaluate time trends in surgical site infection (SSI) rates and SSI pathogens in Australia.DESIGNProspective multicenter observational cohort study.SETTINGA group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System (VICNISS).PATIENTSAll patients underwent surgeries performed between October 1, 2002, and June 30, 2013. National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals.INTERVENTIONProcedure-specific risk-adjusted SSI rates were calculated. Pathogen-specific and antimicrobial-resistant (AMR) infections were modeled using multilevel mixed-effects Poisson regression.RESULTSA total of 183,625 procedures were monitored, and 5,123 SSIs were reported. Each year of observation was associated with 11% risk reduction for superficial SSI (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.88–0.90), 9% risk reduction for deep SSI (RR, 0.91; 95% CI, 0.90–0.93), and 5% risk reduction for organ/space SSI (RR, 0.95; 95% CI, 0.93–0.97). Overall, 3,318 microbiologically confirmed SSIs were reported. Of these SSIs, 1,174 (35.4%) were associated with orthopedic surgery, 827 (24.9%) with coronary artery bypass surgery, 490 (14.8%) with Caesarean sections, and 414 (12.5%) with colorectal procedures. Staphylococcus aureus was the most frequently identified pathogen, and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed (RR, 1.37; 95% CI, 1.10–1.70).CONCLUSIONSStandardized SSI surveillance methods have been implemented in Victoria, Australia. Over an 11-year period, diminishing rates of SSIs have been observed, although AMR infections increased significantly. Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology.Infect Control Hosp Epidemiol 2015;00(0): 1–8

show abstract

“…For example, van Dishoeck et al 21 found a rankability of 80% for surgical-site infection (SSI) after colonic resection but 0% for caesarean section. Rankability was 8% in all operations combined, as the differences in SSI rates were explained mainly by case mix.…”

Section: Discussionmentioning

confidence: 99%