1295. Managed care claims data for surgical site infection (SSI) surveillance following ambulatory surgery
Session: Oral Abstract Session: Surgical Site Infections (SSI)
Saturday, October 20, 2012: 9:30 AM
Room: SDCC 32 AB

Background: An increasing proportion of surgical procedures are performed as ambulatory surgery. Because ambulatory surgery does not involve hospitalization and because complications can be evaluated and treated at other healthcare facilities, routine SSI surveillance methods that rely on hospital-based detection are likely to miss many SSI. We evaluated the utility of automated claims data and electronic health records (EHR) to identify SSI following ambulatory surgery.

Methods: Retrospective cohort study utilizing managed care claims data across 3.7 million member-years for the subset of Harvard Pilgrim Health Care members who received their care through Atrius Health, an alliance of medical groups in Massachusetts. Claims data were used to identify members who underwent select ambulatory surgeries between 1/1/2000 and 12/31/2008. Ambulatory surgery was defined as a surgical procedure not associated with an overnight hospital stay. We identified the subset admitted to an acute care hospital for any reason and/or who received an ICD-9 or CPT code suggestive of infection during an inpatient or ambulatory encounter within 60 days of the procedure, and reviewed their EHR to assess SSI status using CDC definitions.

Results: 4,045 ambulatory surgeries were performed. The proportion of patients with hospitalization or infection codes within 60 days and the positive predictive value (PPV) of hospitalization and infection codes are shown below. Estimated SSI rates based on EHR review ranged from 0% to 3.2%.

Number of procedures

% hospi-talized within 60 days

% with infection codes within 60 days

PPV of hospitalization

PPV of infection codes

SSI rate

Appendectomy

126

6.4%

6.4%

0.13

0.50

3.2%

Anterior cruciate ligament repair

385

1.3%

2.3%

0.20

0.78

1.8%

Herniorrhaphy

1370

2.6%

3.7%

0.13

0.36

1.3%

Cholecystecomy

1126

4.2%

2.2%

0.02

0.24

0.6%

Pacemaker

227

8.8%

3.1%

0

0.14

0.4%

Spinal surgery

325

4.6%

0%

0

N/A

0%

Pubovaginal sling

486

2.1%

0.4%

0

0

0%

Conclusion: Large administrative datasets can track healthcare encounters and identify SSI following ambulatory procedures. The use of claims-based SSI indicators as a tool for ambulatory surgery SSI surveillance deserves further exploration.

Deborah Yokoe, MD, MPH, FSHEA1, Susan S. Huang, MD, MPH, FIDSA2, Julie Lankiewicz, MPH3, Rebecca E. Kaganov, BA3, Christina Bruce, BA3, Sandra Berríos-Torres, MD4, Richard Platt, MD, MS, FSHEA5 and the CDC Prevention Epicenters, (1)Infectious Diseases Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, (2)Department of Medicine, University of California Irvine, Irvine, CA, (3)Harvard Pilgrim Health Care Institute, Boston, MA, (4)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (5)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA

Disclosures:

D. Yokoe, None

S. S. Huang, None

J. Lankiewicz, None

R. E. Kaganov, None

C. Bruce, None

S. Berríos-Torres, None

R. Platt, None

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