Ranking Hospitals Based on Colon Surgery and Abdominal Hysterectomy Surgical Site Infection Outcomes: Impact of Limiting Surveillance to the Operative Hospital

Abstract

Background Hospital-specific surgical site infection (SSI) performance following colon surgery and abdominal hysterectomies can impact hospitals' relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Methods We performed a retrospective cohort study to assess the impact on hospitals' relative SSI performance rankings when SSI detected at nonoperative hospitals are included. We used data from a California statewide hospital registry to assess for evidence of SSI following colon surgery or abdominal hysterectomies performed 1 March 2011 through 30 November 2013 using previously validated claims-based SSI surveillance methods. Risk-adjusted hospital-specific rankings based on SSI detected at operative hospitals versus any California hospital were generated. Results Among 60059 colon surgeries at 285 hospitals and 64918 abdominal hysterectomies at 270 hospitals, 5921 (9.9%) colon surgeries and 1481 (2.3%) abdominal hysterectomies received a diagnosis code for SSI within the 30 days following surgery. Operative hospital surveillance alone would have missed 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSIs. The proportion of an individual hospital's SSIs detected during hospitalizations at other hospitals varied widely. Including nonoperative hospital SSIs resulted in improved relative ranking of 11 (3.9%) colon surgery and 13 (4.8%) hysterectomy hospitals so that they were no longer in the worst performing quartile, mainly among hospitals with relatively high surgical volumes. Conclusions Standard SSI surveillance that mainly focuses on infections detected at the operative hospital causes varying degrees of SSI underestimation, leading to inaccurate assignment or avoidance of financial penalties for approximately 1 in 11-16 hospitals.