Superficial Surgical Site Infections Shown to be Reliable Measure of Hospital Quality

June 6, 2011

Rates of superficial surgical site infections (SSI) are often used as measures of hospital quality, vialis 40mg although the statistical reliability is uncertain. A recent study published early online in the Journal of the American College of Surgeons on May 30, viagra 2011, looked at data to “determine the reliability of SSI rates as a measure of hospital performance and to evaluate the effect of hospital caseload on reliability.”

The researchers used American College of Surgeons National Surgical Quality Improvement Program data, examining patients who underwent colon resection in hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program in 2007. The data set contained 18,455 patients and 181 hospitals. The number of cases and risk-adjusted rate of SSI was calculated for each hospital. Hierarchical modeling to estimate the reliability of SSI as a quality measure was used for each hospital. The proportion of hospital-level variation of SSI rates due to patient characteristics and measurement noise was quantified.

The hospital study subjects were found to have an average of 102 colon resections (SD 65). After risk-adjustment, the superficial SSI rate was 10.5%, but a variation of 0 to 30% was seen across hospitals. According to the researchers, approximately 35% of this variation in SSI rates was due to noise, 7% was attributable to patient characteristics, and the remaining 58% was representative of true differences in SSI rates. More than half of the subject hospitals (54%) exhibited a reliability greater than .70, which according to the researchers is considered a minimum acceptable level. Ninety-four cases were required to achieve this level of reliability.

The authors concluded that “SSI rates are a reliable measure of hospital quality when an adequate number of cases have been reported.” In hospitals with an inadequate number of cases, “the National Surgical Quality Improvement Program sampling strategy could be altered to provide enough cases to ensure reliability.”

Reference: Kao, LS, Ghaferi, AA, Ko, CY, and JB Dimick. (2011). Reliability of superficial Surgical Site Infections as a Hospital Quality Measure. Journal of the American College of Surgeons. Published online May 30, 2011.

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