Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data

Afif N. Kulaylat, Brett Engbrecht, Dorothy Rocourt, John M. Rinaldi, Mary Catherine Santos, Robert Cilley, Christopher S. Hollenbeak, Peter Dillon

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Surgical site infections (SSIs) are an important end point and measure of quality of care. Surgical site infections can be identified using clinical registries, electronic surveillance, and administrative claims data. This study compared measurements of SSIs using these 3 different methods and estimated their implication for health care costs. Study Design Data were obtained from 5,476 surgical patients treated at a single academic children's hospital (January 1, 2010 through August 31, 2014). Surgical site infections within 30 days were identified using a clinical registry in the NSQIP Pediatric, an electronic surveillance method (Nosocomial Infection Marker; MedMined), and billing claims. Infection rates, diagnostic characteristics, and attributable costs were estimated for each of the 3 measures of SSI. Results Surgical site infections were observed in 2.24% of patients per NSQIP Pediatric definitions, 0.99% of patients per the Nosocomial Infection Marker, and 2.34% per billing claims definitions. Using NSQIP Pediatric as the clinical reference, Nosocomial Infection Marker had a sensitivity of 31.7% and positive predictive value of 72.2%, and billing claims had a sensitivity of 48.0% and positive predictive value of 46.1% for detection of an SSI. Nosocomial Infection Marker and billing claims overestimated the costs of SSIs by 108% and 41%, respectively. Conclusions There is poor correlation among SSIs measured using electronic surveillance, administrative claims, and clinically derived measures of SSI in the pediatric surgical population. Although these measures might be more convenient, clinically derived data, such as NSQIP Pediatric, may provide a more appropriate quality metric to estimate the postoperative burden of SSIs in children.

Original languageEnglish (US)
Pages (from-to)823-830
Number of pages8
JournalJournal of the American College of Surgeons
Volume222
Issue number5
DOIs
StatePublished - May 1 2016

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Surgical Wound Infection
Cross Infection
Pediatrics
Registries
Costs and Cost Analysis
Quality of Health Care
Health Care Costs

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{0b930cbcc2b240dca96ce28f420a64c7,
title = "Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data",
abstract = "Background Surgical site infections (SSIs) are an important end point and measure of quality of care. Surgical site infections can be identified using clinical registries, electronic surveillance, and administrative claims data. This study compared measurements of SSIs using these 3 different methods and estimated their implication for health care costs. Study Design Data were obtained from 5,476 surgical patients treated at a single academic children's hospital (January 1, 2010 through August 31, 2014). Surgical site infections within 30 days were identified using a clinical registry in the NSQIP Pediatric, an electronic surveillance method (Nosocomial Infection Marker; MedMined), and billing claims. Infection rates, diagnostic characteristics, and attributable costs were estimated for each of the 3 measures of SSI. Results Surgical site infections were observed in 2.24{\%} of patients per NSQIP Pediatric definitions, 0.99{\%} of patients per the Nosocomial Infection Marker, and 2.34{\%} per billing claims definitions. Using NSQIP Pediatric as the clinical reference, Nosocomial Infection Marker had a sensitivity of 31.7{\%} and positive predictive value of 72.2{\%}, and billing claims had a sensitivity of 48.0{\%} and positive predictive value of 46.1{\%} for detection of an SSI. Nosocomial Infection Marker and billing claims overestimated the costs of SSIs by 108{\%} and 41{\%}, respectively. Conclusions There is poor correlation among SSIs measured using electronic surveillance, administrative claims, and clinically derived measures of SSI in the pediatric surgical population. Although these measures might be more convenient, clinically derived data, such as NSQIP Pediatric, may provide a more appropriate quality metric to estimate the postoperative burden of SSIs in children.",
author = "Kulaylat, {Afif N.} and Brett Engbrecht and Dorothy Rocourt and Rinaldi, {John M.} and Santos, {Mary Catherine} and Robert Cilley and Hollenbeak, {Christopher S.} and Peter Dillon",
year = "2016",
month = "5",
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doi = "10.1016/j.jamcollsurg.2016.01.004",
language = "English (US)",
volume = "222",
pages = "823--830",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
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TY - JOUR

T1 - Measuring Surgical Site Infections in Children

T2 - Comparing Clinical, Electronic, and Administrative Data

AU - Kulaylat, Afif N.

AU - Engbrecht, Brett

AU - Rocourt, Dorothy

AU - Rinaldi, John M.

AU - Santos, Mary Catherine

AU - Cilley, Robert

AU - Hollenbeak, Christopher S.

AU - Dillon, Peter

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background Surgical site infections (SSIs) are an important end point and measure of quality of care. Surgical site infections can be identified using clinical registries, electronic surveillance, and administrative claims data. This study compared measurements of SSIs using these 3 different methods and estimated their implication for health care costs. Study Design Data were obtained from 5,476 surgical patients treated at a single academic children's hospital (January 1, 2010 through August 31, 2014). Surgical site infections within 30 days were identified using a clinical registry in the NSQIP Pediatric, an electronic surveillance method (Nosocomial Infection Marker; MedMined), and billing claims. Infection rates, diagnostic characteristics, and attributable costs were estimated for each of the 3 measures of SSI. Results Surgical site infections were observed in 2.24% of patients per NSQIP Pediatric definitions, 0.99% of patients per the Nosocomial Infection Marker, and 2.34% per billing claims definitions. Using NSQIP Pediatric as the clinical reference, Nosocomial Infection Marker had a sensitivity of 31.7% and positive predictive value of 72.2%, and billing claims had a sensitivity of 48.0% and positive predictive value of 46.1% for detection of an SSI. Nosocomial Infection Marker and billing claims overestimated the costs of SSIs by 108% and 41%, respectively. Conclusions There is poor correlation among SSIs measured using electronic surveillance, administrative claims, and clinically derived measures of SSI in the pediatric surgical population. Although these measures might be more convenient, clinically derived data, such as NSQIP Pediatric, may provide a more appropriate quality metric to estimate the postoperative burden of SSIs in children.

AB - Background Surgical site infections (SSIs) are an important end point and measure of quality of care. Surgical site infections can be identified using clinical registries, electronic surveillance, and administrative claims data. This study compared measurements of SSIs using these 3 different methods and estimated their implication for health care costs. Study Design Data were obtained from 5,476 surgical patients treated at a single academic children's hospital (January 1, 2010 through August 31, 2014). Surgical site infections within 30 days were identified using a clinical registry in the NSQIP Pediatric, an electronic surveillance method (Nosocomial Infection Marker; MedMined), and billing claims. Infection rates, diagnostic characteristics, and attributable costs were estimated for each of the 3 measures of SSI. Results Surgical site infections were observed in 2.24% of patients per NSQIP Pediatric definitions, 0.99% of patients per the Nosocomial Infection Marker, and 2.34% per billing claims definitions. Using NSQIP Pediatric as the clinical reference, Nosocomial Infection Marker had a sensitivity of 31.7% and positive predictive value of 72.2%, and billing claims had a sensitivity of 48.0% and positive predictive value of 46.1% for detection of an SSI. Nosocomial Infection Marker and billing claims overestimated the costs of SSIs by 108% and 41%, respectively. Conclusions There is poor correlation among SSIs measured using electronic surveillance, administrative claims, and clinically derived measures of SSI in the pediatric surgical population. Although these measures might be more convenient, clinically derived data, such as NSQIP Pediatric, may provide a more appropriate quality metric to estimate the postoperative burden of SSIs in children.

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U2 - 10.1016/j.jamcollsurg.2016.01.004

DO - 10.1016/j.jamcollsurg.2016.01.004

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VL - 222

SP - 823

EP - 830

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

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