January 09, 2013
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SSI risk after hip arthroplasty more likely at lower-ranked hospitals

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After ranking hospitals based on factors associated with surgical site infection, researchers found that patients who underwent hip arthroplasty at a hospital in the worst-performing decile were more likely to develop a surgical site infection.

“Medicare claims data successfully ranked US hospitals on the basis of [surgical site infection] risk after hip arthroplasty and demonstrated a threefold rate difference between the worst- vs. best-performing hospitals,” Michael Calderwood, MD, MPH, of Harvard Medical School and Harvard Pilgrim Health Care Institute, told Infectious Disease News. “This methodology can be implemented by hospitals for more comprehensive and efficient [surgical site infection] detection.”

Michael Calderwood, MD 

Michael Calderwood

Calderwood and colleagues ranked hospitals according to data retrieved from claims codes that suggested surgical site infection (SSI). The ranks were adjusted for age, sex and comorbidities. They evaluated medical records from patients in hospitals in the worst-performing and best-performing deciles to validate infection and calculate the risk of developing an SSI after hip arthroplasty.

From 2005 to 2007, there were 524,892 Medicare patients who underwent hip arthroplasty in 3,296 hospitals in the United States. Among the 329 hospitals in the best-performing decile, 4.3% of patients had at least one code that suggested SSI vs. 14.9% of patients in the 329 hospitals in the worst-performing decile.

In a random selection of 1,000 patients whose charts were requested, there were 251 confirmed SSIs and 97% of these were diagnosed after hospital discharge. There were 76 superficial incisional SSIs and 175 deep incisional and organ/space SSIs.

“Identifying a standardized and efficient approach for SSI surveillance is highly valuable because public reporting of SSIs is increasingly mandated,” Calderwood said. “Claims data can help validate the accuracy and completeness of self-reported data and, ultimately, improve the meaningfulness of interhospital comparisons. This is particularly important as payers such as Medicare implement value-based purchasing programs that target SSI as a measure of hospital quality.”

Michael Calderwood, MD, MPH, can be reached at mcalderwood@partners.org.

Disclosure: Calderwood reports no relevant financial disclosures.