None of the authors has any disclosures or conflicts of interest to report

Transcription

1 None of the authors has any disclosures or conflicts of interest to report

2 The Effect OF PATOS (Present At the Time Of Surgery) On The Calculation of SSI Rates for Appendectomy and Colectomy: Is PATOS a Useful Concept? Albert W Dibbins, MD, FACS David E Clark, MD, MS,FACS Robert Cormier, BSN Department of Surgery Maine Medical Center Portland, Maine

3 Effect of Assigning PATOS 1. An assigned postoperative wound or organ space infection is not counted 2. It does not appear in the hospital s Select Postoperative Occurrence Summary 3. It does not appear in the hospital s Semi Annual Report (SAR) 4. It is retained in the hospital s NSQIP database and is retrievable using the Data Download tool

4 Methods Adult NSQIP Participant User Files (PUF) from were examined to estimate the effect of pre-operative perforation and the effect of assigning PATOS on the rates of Surgical Site Infection for Appendectomies (91,029 cases, open and laparoscopic) and Colectomies (105,553 cases, open and laparoscopic) Cases were determined to have definite preoperative infection if the CPT or ICD-9 code specified intestinal perforation, peritonitis, or abscess. For all years, rates of surgical site infection were calculated comparing cases with and without definite preoperative infection. For 2011 and 2012 data, the rates of superficial, deep, and organ space infection were calculated comparing results before and after excluding PATOS cases. Statistical significance for comparisons was determined using Pearson chi-square analysis.

5 Effect of Intestinal Perforation/Abscess on Rates of SSI (Percent) Appendectomy RR %CI Any WI SWI DWI OSI Year No Preoperative Infection Preoperative Infection

6 Effect of Intestinal Perforation/Abscess on Rates of SSI (Percent) Colectomy RR %CI Any WI SWI DWI OSI Year Preoperative Infection No Preoperative Infection

7 Effect of PATOS on Rates of Wound Infection (Percent) Appendectomy For 2012, RR %CI Any WI SWI DWI OSI Year Not Adjusted for PATOS Adjusted for PATOS

8 Effect of PATOS on Rates of Wound Infection (percent) Colectomy For 2012, RR %CI Any WI SWI DWI OSI Year Not Adjusted for PATOS Adjusted for PATOS

9 PATOS Definitions for Surgical Site Infections Superficial Incisional SSI - PATOS Evidence or suspicion of a superficial infection found at the intended surgical site. This must be noted preoperatively or found intra-operatively at the surgical site and may include an open wound, cellulitis (erythema, tenderness AND swelling), or wound infection. Deep Incisional SSI PATOS Evidence or suspicion of a deep infection (e.g., muscle and fascia layers) found at the intended surgical site. This must be noted preoperatively or found intra-operatively at the surgical site and may include an open wound, cellulitis (erythema, tenderness AND swelling), or wound infection. Organ Space SSI PATOS Evidence or suspicion of an abscess or other infection involving the organ or space manipulated during the operation. This must be noted preoperatively or found intra-operatively in the surgical space

10 PATOS Misclassification Assigning YES to SWI and DWI Assigning NO to OSI Appendectomy SWI cases 38 assigned YES = 29% misclassified DWI - 59 cases 28 assigned YES = 47% misclassified OSI cases 118 assigned NO = 25% misclassified Colectomy SWI cases 24 assigned YES = 21% misclassified DWI - 68 cases 29 assigned YES = 42% misclassified OSI cases 63 assigned NO = 29% misclassified

11 Conclusions Is PATOS a useful concept? NO! Reporting all Surgical Site Infections stratified by the presence or absence of preoperative infection would provide better data to the individual sites and would not obscure important results Although the total number of misclassifications is small, it appears that further education in the proper assigning of the PATOS variables would improve the data which is acquired

12 NHSN SSI Reporting If a patient has an infection in the organ space being operated on, subsequent continuation of this infection type during the remainder of the surveillance period is considered an organ space SSI, if organ space SSI and site-specific infection criteria are met.