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Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data.
Spine (Phila Pa 1976). 2012 Jul 01; 37(15):1340-5.S

Abstract

STUDY DESIGN

Retrospective analysis.

OBJECTIVE

The objective of this study was to investigate the accuracy of using an automated approach to administrative claims data to assess the rate and risk factors for surgical site infection (SSI) in spinal procedures.

SUMMARY OF BACKGROUND DATA

SSI is a major indicator of health care quality. A wide range of SSI rates have been proposed in the literature depending on clinical setting and procedure type.

METHODS

All spinal surgeries performed at a university-affiliated tertiary-care center from July 2005 to December 2010 were identified using diagnosis-related group, current procedural terminology, and International Classification of Diseases, Ninth Revision (ICD-9) codes and were validated through chart review. Rates of SSI and associated risk factors were calculated using univariate regression analysis. Odds ratios were calculated through multivariate logistic regression.

RESULTS

A total of 6628 hospital visits were identified. The cumulative incidence of SSI was 2.9%. Procedural risk factors associated with a statistically significant increase in rates of infection were the following: sacral involvement (9.6%), fusions greater than 7 levels (7.8%), fusions greater than 12 levels (10.4%), cases with an osteotomy (6.5%), operative time longer than 5 hours (5.1%), transfusions of red blood cells (5.0%), serum (7.4%), and autologous blood (4.1%). Patient-based risk factors included anemia (4.3%), diabetes mellitus (4.2%), coronary artery disease (4.7%), diagnosis of coagulopathy (7.8%), and bone or connective tissue neoplasm (5.0%).

CONCLUSION

Used individually, diagnosis-related group, current procedural terminology, and ICD-9 codes cannot completely capture a patient population. Using an algorithm combining all 3 coding systems to generate both inclusion and exclusion criteria, we were able to analyze a specific population of spinal surgery patients within a high-volume medical center. Within that group, risk factors found to increase infection rates were isolated and can serve to focus hospital-wide efforts to decrease surgery-related morbidity and improve patient outcomes.

Authors+Show Affiliations

Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143, USA. amir.abdul-jabbar@ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22210012

Citation

Abdul-Jabbar, Amir, et al. "Surgical Site Infection in Spinal Surgery: Description of Surgical and Patient-based Risk Factors for Postoperative Infection Using Administrative Claims Data." Spine, vol. 37, no. 15, 2012, pp. 1340-5.
Abdul-Jabbar A, Takemoto S, Weber MH, et al. Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. Spine (Phila Pa 1976). 2012;37(15):1340-5.
Abdul-Jabbar, A., Takemoto, S., Weber, M. H., Hu, S. S., Mummaneni, P. V., Deviren, V., Ames, C. P., Chou, D., Weinstein, P. R., Burch, S., & Berven, S. H. (2012). Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. Spine, 37(15), 1340-5. https://doi.org/10.1097/BRS.0b013e318246a53a
Abdul-Jabbar A, et al. Surgical Site Infection in Spinal Surgery: Description of Surgical and Patient-based Risk Factors for Postoperative Infection Using Administrative Claims Data. Spine (Phila Pa 1976). 2012 Jul 1;37(15):1340-5. PubMed PMID: 22210012.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. AU - Abdul-Jabbar,Amir, AU - Takemoto,Steven, AU - Weber,Michael H, AU - Hu,Serena S, AU - Mummaneni,Praveen V, AU - Deviren,Vedat, AU - Ames,Christopher P, AU - Chou,Dean, AU - Weinstein,Philip R, AU - Burch,Shane, AU - Berven,Sigurd H, PY - 2012/1/3/entrez PY - 2012/1/3/pubmed PY - 2012/12/10/medline SP - 1340 EP - 5 JF - Spine JO - Spine (Phila Pa 1976) VL - 37 IS - 15 N2 - STUDY DESIGN: Retrospective analysis. OBJECTIVE: The objective of this study was to investigate the accuracy of using an automated approach to administrative claims data to assess the rate and risk factors for surgical site infection (SSI) in spinal procedures. SUMMARY OF BACKGROUND DATA: SSI is a major indicator of health care quality. A wide range of SSI rates have been proposed in the literature depending on clinical setting and procedure type. METHODS: All spinal surgeries performed at a university-affiliated tertiary-care center from July 2005 to December 2010 were identified using diagnosis-related group, current procedural terminology, and International Classification of Diseases, Ninth Revision (ICD-9) codes and were validated through chart review. Rates of SSI and associated risk factors were calculated using univariate regression analysis. Odds ratios were calculated through multivariate logistic regression. RESULTS: A total of 6628 hospital visits were identified. The cumulative incidence of SSI was 2.9%. Procedural risk factors associated with a statistically significant increase in rates of infection were the following: sacral involvement (9.6%), fusions greater than 7 levels (7.8%), fusions greater than 12 levels (10.4%), cases with an osteotomy (6.5%), operative time longer than 5 hours (5.1%), transfusions of red blood cells (5.0%), serum (7.4%), and autologous blood (4.1%). Patient-based risk factors included anemia (4.3%), diabetes mellitus (4.2%), coronary artery disease (4.7%), diagnosis of coagulopathy (7.8%), and bone or connective tissue neoplasm (5.0%). CONCLUSION: Used individually, diagnosis-related group, current procedural terminology, and ICD-9 codes cannot completely capture a patient population. Using an algorithm combining all 3 coding systems to generate both inclusion and exclusion criteria, we were able to analyze a specific population of spinal surgery patients within a high-volume medical center. Within that group, risk factors found to increase infection rates were isolated and can serve to focus hospital-wide efforts to decrease surgery-related morbidity and improve patient outcomes. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/22210012/Surgical_site_infection_in_spinal_surgery:_description_of_surgical_and_patient_based_risk_factors_for_postoperative_infection_using_administrative_claims_data_ L2 - https://doi.org/10.1097/BRS.0b013e318246a53a DB - PRIME DP - Unbound Medicine ER -