502. Surgical Surveillance in the Era of Bundled Payment: Balancing Patient Safety with Institutional and Surgeon Risk
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

Background:

Centers for Medicare & Medicaid Services (CMS) new Bundled Payments Initiative places hospitals at financial risk for surgical site infections (SSI).  Surgeons may be penalized for SSI and may avoid operating on patients at high infection risk.   Surveillance must identify SSI modifiable and non-modifiable risk factors (RF) for SSI and provide individual surgeons distribution of RF in their patients.  SSI should be classified as non-preventable (when modifiable RF addressed by surgical team) or preventable (modifiable RF not addressed). 

Methods:

We classified arthroplasty (arthro), spine fusion (SF), cardiac bypass graft and valve (CABG) procedures during 2009-2011 according to National Health Safety Network (NHSN) ICD-9 groupings, and identified SSI using NHSN case definitions.  Demographics, clinical and microbiology data, surgical parameters were abstracted from medical and administrative databases.  Univariate and multivariate logistic regression (MLR) was performed in SAS v 9.3 to determine significant RF associated with the above procedures.

Results:

Arthro procedures were stratified by same day (SD) and non-same day (NSD) admission given the difference in deep SSI rates (.8% vs 4.7%, p<.0001).  Smoking, BMI>40, and S. aureus colonization were found significant (p<.05) by MLR in SD arthro; uncontrolled diabetes (DM), and BMI>40 in orthosurgical (ortho) SF and neurosurgical (NS) SF.  Potentially modifiable RF were identified by surgery type (Table).

Table. Significant modifiable RF by surgery type during 2009-2011

Modifiable RF

SD Arthro

(N=7,002)

NSD Arthro

(N=494)

Ortho SF

(N=2,655)

NS SF

(N=1,207)

CABG

(N=1,901)

Tobacco use within month

X

X

Uncontrolled diabetes

X

X

S. aureus colonization

X

BMI > 40

X

X

X

Conclusion:

Classification of SSI as preventable vs. non-preventable based on addressing the modifiable RF in our institution and those  found in current literature such as hypo/hyperthermia, perioperative antibiotic dosing, and glucose control allows for focusing of prevention efforts.  This holds surgeons accountable for minimizing SSI without undue dissuasion from operating on higher risk patients in this era bundled payments.

Anna Stachel, MPH, Infection Prevention and Control, New York University Langone Medical Center, New York, NY, Robert Press, MD, PhD, New York University Langone Medical Center, New York, NY, Tania Bubb, RN, Infection Protection and Control, New York Univsersity Langone Medical Center, New York, NY, Faith Skeete, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY and Michael S. Phillips, MD, Infection Prevention and Control, NYU Langone Medical Center, New York, NY

Disclosures:

A. Stachel, None

R. Press, None

T. Bubb, None

F. Skeete, None

M. S. Phillips, 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.