Hedrick Traci L, Harrigan Amy M, Sawyer Robert G, Turrentine Florence E, Stukenborg George J, Umapathi Bindu A, Friel Charles M
1 Department of Surgery, University of Virginia, Charlottesville, Virginia 2 Department of Health Evaluation Sciences, University of Virginia, Charlottesville, Virginia.
Dis Colon Rectum. 2015 Nov;58(11):1070-7. doi: 10.1097/DCR.0000000000000466.
Surgical site infection is common following colorectal surgery, yet the incidence varies widely. CDC criteria include "diagnosis by attending physician," which can be subjective. Alternatively, the ASEPSIS score is an objective scoring system based on the presence of clinical findings.
The aim of this study is to compare the interrater reliability of the ASEPSIS score vs CDC definitions in identifying surgical site infection.
This 24-month prospective study used serial photography of the wound. Three attending surgeons independently reviewed blinded photographic/clinical data.
This study was conducted at an academic institution.
Patients undergoing elective colorectal surgery were selected.
Surgeons assigned an ASEPSIS score and identified surgical site infection by using CDC definitions. The interrater reliability of ASEPSIS and the CDC criteria were compared by using the κ statistic. These data were also compared with the institutional National Surgical Quality Improvement Program database.
One hundred seventy-one patients were included. Four surgical site infections (2.4%) were identified by the National Surgical Quality Improvement Program. Data from the surgeons demonstrated significantly higher yet discrepant rates of infection by the CDC criteria, at 6.2%, 7.4%, and 14.1% with a κ of 0.55 indicating modest interrater agreement. Alternatively, the ASEPSIS assessments demonstrated excellent interrater agreement between surgeons with 96% agreement (2.4%, 2.4%, and 3.6%) and a κ of 0.83.
This was a single-institution study.
This study demonstrates the relatively poor reliability of CDC definitions for surgical site infections in comparison with an objective scoring system. These findings could explain the wide variability in the literature and raise concern for the comparison of institutional surgical site infection rates as a quality indicator. Alternatively, an objective scoring system, like the ASEPSIS score, may yield more reliable measures for comparison.
结直肠手术后手术部位感染很常见，但发病率差异很大。美国疾病控制与预防中心（CDC）的标准包括“由主治医生诊断”，这可能具有主观性。另外，ASEPSIS评分是一种基于临床发现的客观评分系统。
本研究的目的是比较ASEPSIS评分与CDC定义在识别手术部位感染方面的评分者间信度。
这项为期24个月的前瞻性研究采用了伤口的系列照片。三位主治外科医生独立审查了盲法摄影/临床数据。
本研究在一家学术机构进行。
选择接受择期结直肠手术的患者。
外科医生给出ASEPSIS评分，并使用CDC定义确定手术部位感染。通过κ统计量比较ASEPSIS和CDC标准的评分者间信度。这些数据也与机构的国家外科质量改进计划数据库进行了比较。
纳入了171例患者。国家外科质量改进计划确定了4例手术部位感染（2.4%）。外科医生的数据显示，根据CDC标准，感染率显著更高但存在差异，分别为6.2%、7.4%和14.1%，κ值为0.55，表明评分者间一致性一般。另外，ASEPSIS评估显示外科医生之间的评分者间一致性极佳，一致性为96%（2.4%、2.4%和3.6%），κ值为0.83。
这是一项单机构研究。
本研究表明，与客观评分系统相比，CDC定义的手术部位感染可靠性相对较差。这些发现可以解释文献中广泛的变异性，并引发对将机构手术部位感染率作为质量指标进行比较的担忧。另外，像ASEPSIS评分这样的客观评分系统可能会产生更可靠的比较指标。
