1453. Risk Adjustment of Surgical Site Infection Rates Following Colon Surgery
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • 1453_Teresa Childers_MSKCC_45x22_10.4.16.pdf (765.6 kB)
  • Background:  Surgical site infections (SSI) are among the most common healthcare associated infections (HAI) in the United States. As public reporting of SSI rates is mandatory in many states and tied to payment determinations, development of reliable and accurate oncology specific benchmarks is needed to ensure that oncology centers are fairly compared.

    Methods: 

    National Surgical Quality Improvement Program (NSQIP) data files for 2011, 2012, and 2013 from a sample of 11 National Comprehensive Cancer Network (NCCN) Member Institutions were combined. Procedures were selected by principle procedure CPT code and included incision, resection or anastomosis of the large intestine. A cancer cohort was defined by diagnostic discharge ICD-9-CM code. SSI risk was evaluated for factors collected during routine NSQIP surveillance. The independent importance of potential risk factors was assessed using logistic regression: a p-value of 0.05 was required for statistical significance.

    Results: A total of 5893 colon procedures and 652 SSI were reported (overall rate 11.06 per 100 surgeries). Among 3137 procedures in the cancer group, 347 SSI were reported (11.06 per 100 surgeries). Among 2756 procedures in the non-cancer group, 305 SSI were reported (11.07 per 100 surgeries). Significant risk factors found on univariate analysis included BMI, diabetes, history of smoking, COPD, ascites, disseminated cancer, wound class, ASA, duration of procedure, multiple procedures, approach, hypertension, and chronic steroid use. Independent predictors of SSI risk in the logistic regression model included BMI, ASA, diabetes, COPD, disseminated cancer, duration of procedure and chronic steroid use.

    Conclusion:  No differences were seen among patients with and without underlying cancer. Patients with disseminated cancer were at higher risk for developing SSI. Other variables that predicted SSI risk were BMI>30, diabetes, ASA score>3, COPD, immunosuppressant and steroid use and longer duration of surgery. Cancer diagnosis should be further evaluated when generating risk-adjusted outcomes.

    Teresa Childers, MPH, CIC1, Mini Kamboj, MD1, Jessica Sugalski, MPPA2, Donna Antonelli, BS, CPHQ3, Juliane Bingener-Casey, MD4, Jamie Cannon, MD5, Karie Cluff, BSN, RN6, Kimberly a. Davis, MD, MBA7, Patchen E. Dellinger, MD8, Sean Dowdy, MD9, Kim Duncan, MD10, Julie Fedderson, MD10, Robert Glasgow, MD11, Bruce Hall, MD, PhD12, Marilyn Hirsch, RN, MS13, Matthew Hutter, MD14, Lisa Kimbro, MBA, CPA2, Boris Kuvshinoff II, MD, MBA15, Martin Makary, MD, MPH16, Melanie Morris, MD5, Sharon Nehring, RN, BSN17, Sonia Ramamoorthy, MD, FACS, FASCRS18, Rebekah Scott, MSN, MBA/HC, PHN, RN18, Mindy Sovel, MPH, MA19, Vivian Strong, MD19, Ashley Webster, RN, BSN, CNOR20, Elizabeth Wick, MD16, Robert Carlson, MD2 and Kent Sepkowitz, MD, FIDSA, FSHEA21, (1)Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, (2)National Comprehensive Cancer Network, Fort Washington, PA, (3)Department of Surgery, Massachusetts General Hospital, Boston, MA, (4)Department of Surgery, Mayo Clinic - Minnesota, Rochester, MN, (5)UAB Medicine, Birmingham, AL, (6)University of Utah Medical Center, Salt Lake City, UT, (7)Surgery, Yale University School of Medicine, New Haven, CT, (8)Department of Surgery, University of Washington, Seattle, WA, (9)Department of Surgery, Mayo Clinic, Rochester, MN, (10)University of Nebraska Medical Center, Omaha, NE, (11)Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, (12)Barnes-Jewish Hospital, Washington University in Saint Louis, St. Louis, MO, (13)Yale-New Haven Hospital, New Haven, CT, (14)General & Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, (15)Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, (16)Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, (17)Surgery Clinical Research Office, Mayo Clinic - Minnesota, Rochester, MN, (18)University of California, San Diego Health System, San Diego, CA, (19)Memorial Sloan Kettering, New York, NY, (20)Quality Improvement, UAB Hospital, Birmingham, AL, (21)Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY

    Disclosures:

    T. Childers, None

    M. Kamboj, None

    J. Sugalski, None

    D. Antonelli, None

    J. Bingener-Casey, None

    J. Cannon, None

    K. Cluff, None

    K. A. Davis, None

    P. E. Dellinger, None

    S. Dowdy, None

    K. Duncan, None

    J. Fedderson, None

    R. Glasgow, None

    B. Hall, None

    M. Hirsch, None

    M. Hutter, None

    L. Kimbro, None

    B. Kuvshinoff II, None

    M. Makary, None

    M. Morris, None

    S. Nehring, None

    S. Ramamoorthy, None

    R. Scott, None

    M. Sovel, None

    V. Strong, None

    A. Webster, None

    E. Wick, None

    R. Carlson, None

    K. Sepkowitz, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.