500. Improving Surveillance for Deep and Organ/Space Surgical Site Infections Following Coronary Artery Bypass Graft Surgery and Hip Arthroplasty
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Calderwood_IDSA2013_Hip_CABG_Deep_OS_SSI_Claims_Codes_Poster_Submitted.pdf (539.4 kB)
  • Background: Deep and organ/space surgical site infections (D/OS SSI) are an important and potentially preventable cause of morbidity and mortality. Billing codes may offer a standardized trigger for chart review and case confirmation of D/OS SSI.

    Methods: We analyzed data from prior national validation studies which used Medicare claims suggesting SSI to trigger chart review and confirm all SSI following coronary artery bypass graft (CABG) surgery and hip arthroplasty. This included 50 ICD-9 codes for CABG and 43 ICD-9 codes for hip arthroplasty. Using code performance characteristics (sensitivity and positive predictive value (PPV)), we identified the subset of ICD-9 codes that best identified confirmed D/OS SSI. Codes were analyzed individually and in combination. D/OS SSI codes were selected to maximize sensitivity while maintaining moderate PPV.

    Results: Among charts with trigger codes targeting all SSI, we confirmed D/OS SSI in 15% (143/980) of post-CABG patients and in 28% (175/628) of post-hip arthroplasty patients. Nineteen ICD-9 codes captured 97% (139/143) of D/OS SSI following CABG with a PPV of 22% (139/620). On average, we identified a post-CABG D/OS SSI for every 4.5 patients reviewed. For hip arthroplasty, 6 ICD-9 codes captured 99% (174/175) of D/OS SSI with a PPV of 70% (174/248). On average, we identified a post-arthroplasty D/OS SSI for every 1.4 patients reviewed. 


    ICD-9-CM Codes Suggestive of Deep Incisional or Organ/Space SSI


    34.01, 34.10, 86.04, 86.22, 513.1, 519.2, 682.2, 682.8, 730.00, 730.08, 730.20, 730. 28, 996.61, 996.62, 998.31, 998.32, 998.51, 998.59, and 998.83

    Hip Arthroplasty

    996.60, 996.66, 996.67, 996.69, 998.51, and 998.59

    Conclusion: Billing codes efficiently identified patients with D/OS SSI following CABG and hip arthroplasty. Comprehensive approaches for detecting D/OS SSIs are critical for valid inter-hospital comparisons and targeted quality improvement interventions.

    Michael S. Calderwood, MD, MPH1,2, Ken Kleinman, ScD1, Claire Canning, MA1, Julie Lankiewicz, MPH1, Richard Platt, MD MS1 and Susan S. Huang, MD, MPH, FIDSA3, (1)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (2)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, (3)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA


    M. S. Calderwood, None

    K. Kleinman, None

    C. Canning, None

    J. Lankiewicz, None

    R. Platt, None

    S. S. Huang, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.