Anderson Deverick J, Chen Luke F, Sexton Daniel J, Kaye Keith S
Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina 27710, USA.
Infect Control Hosp Epidemiol. 2008 Oct;29(10):941-6. doi: 10.1086/591457.
To validate the National Nosocomial Infection Surveillance (NNIS) risk index as a tool to account for differences in case mix when reporting rates of complex surgical site infection (SSI).
Prospective cohort study.
Twenty-four community hospitals in the southeastern United States.
We identified surgical procedures performed between January 1, 2005, and June 30, 2007. The Goodman-Kruskal gamma or G statistic was used to determine the correlation between the NNIS risk index score and the rates of complex SSI (not including superficial incisional SSI). Procedure-specific analyses were performed for SSI after abdominal hysterectomy, cardiothoracic procedures, colon procedures, insertion of a hip prosthesis, insertion of a knee prosthesis, and vascular procedures.
A total of 2,257 SSIs were identified during the study period (overall rate, 1.19 SSIs per 100 procedures), of which 1,093 (48.4%) were complex (0.58 complex SSIs per 100 procedures). There were 45 complex SSIs identified following 7,032 abdominal hysterectomies (rate, 0.64 SSIs per 100 procedures); 63 following 5,318 cardiothoracic procedures (1.18 SSIs per 100 procedures); 139 following 5,144 colon procedures (2.70 SSIs per 100 procedures); 63 following 6,639 hip prosthesis insertions (0.94 SSIs per 100 procedures); 73 following 9,658 knee prosthesis insertions (0.76 SSIs per 100 procedures); and 55 following 6,575 vascular procedures (0.84 SSIs per 100 procedures). All 6 procedure-specific rates of complex SSI were significantly correlated with increasing NNIS risk index score (P<.05).
Some experts recommend reporting rates of complex SSI to overcome the widely acknowledged detection bias associated with superficial incisional infection. Furthermore, it is necessary to compensate for case-mix differences in patient populations, to ensure that intrahospital comparisons are meaningful. Our results indicate that the NNIS risk index is a reasonable method for the risk stratification of complex SSIs for several commonly performed procedures.
验证国家医院感染监测（NNIS）风险指数作为一种工具，用于在报告复杂手术部位感染（SSI）发生率时考虑病例组合的差异。
前瞻性队列研究。
美国东南部的24家社区医院。
我们确定了2005年1月1日至2007年6月30日期间进行的手术程序。使用古德曼-克鲁斯卡尔伽马或G统计量来确定NNIS风险指数评分与复杂SSI（不包括浅表切口SSI）发生率之间的相关性。对腹部子宫切除术后、心胸手术、结肠手术、髋关节假体植入、膝关节假体植入和血管手术后的SSI进行了特定手术分析。
在研究期间共识别出2257例SSI（总体发生率为每100例手术1.19例SSI），其中1093例（48.4%）为复杂SSI（每100例手术0.58例复杂SSI）。在7032例腹部子宫切除术后识别出45例复杂SSI（发生率为每100例手术0.64例SSI）；5318例心胸手术后63例（每100例手术1.18例SSI）；5144例结肠手术后139例（每100例手术2.70例SSI）；6639例髋关节假体植入后63例（每100例手术0.94例SSI）；9658例膝关节假体植入后73例（每100例手术0.76例SSI）；6575例血管手术后55例（每100例手术0.84例SSI）。所有6种特定手术的复杂SSI发生率均与NNIS风险指数评分的增加显著相关（P<0.05）。
一些专家建议报告复杂SSI的发生率，以克服与浅表切口感染相关的广泛认可的检测偏差。此外，有必要补偿患者群体中的病例组合差异，以确保医院内的比较有意义。我们的结果表明，NNIS风险指数是对几种常见手术的复杂SSI进行风险分层的合理方法。
