Elissa Rennert-May1, Braden Manns2, Stephanie Smith3, Shannon Puloski4, Elizabeth Henderson5, Flora Au6, Kathryn Bush7, John Conly8. 1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: elissa.rennertmay@ucalgary.ca. 2. Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada. 3. Alberta Health Services, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 4. Alberta Health Services, Edmonton, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada. 5. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services Infection Prevention and Control Surveillance Group, Calgary, Alberta, Canada. 6. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 7. Alberta Health Services Infection Prevention and Control Surveillance Group, Calgary, Alberta, Canada. 8. Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada; Department of Immunology, Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Surgical site infections (SSIs) are a substantial burden to healthcare systems in North America. Administrative data is one method though which these may be identified, but the accuracy of using such data is uncertain. METHODS: We followed a population-based cohort of patients who received primary hip/knee arthroplasty in Alberta, Canada, for whom a comprehensive Infection Prevention and Control (IPC) prospective surveillance methodology was used to track SSIs. Patients were also followed using International Classification of Diseases, Tenth Revision (ICD-10) codes. We assessed the sensitivity/specificity and positive/negative predictive values of ICD-10 codes compared to IPC surveillance. RESULTS: Between April 1, 2012, and March 31, 2015, 24,512 people received hip/knee arthroplasty. Of these, 258 (1.05%) had a complex SSI found by IPC surveillance. Sensitivity and specificity of ICD-10 codes in identifying complex SSIs after hip/knee arthroplasty were 85.3% (95% confidence interval [CI] 80.3%-89.4%) and 99.5% (95% CI 99.4%-99.6%), respectively. Positive and negative predictive values were 63.6% (95% CI 58.3%-68.7%) and 99.8% (95% CI 99.8%-99.9%), respectively. DISCUSSION: Administrative data have reasonable testing characteristics for identifying complex SSIs after arthroplasty. For centers without prospective surveillance programs, this could be useful in identifying hospitals with frequent complex SSIs after arthroplasty. CONCLUSIONS: A comprehensive IPC surveillance program is superior at detecting SSIs after arthroplasty.
BACKGROUND: Surgical site infections (SSIs) are a substantial burden to healthcare systems in North America. Administrative data is one method though which these may be identified, but the accuracy of using such data is uncertain. METHODS: We followed a population-based cohort of patients who received primary hip/knee arthroplasty in Alberta, Canada, for whom a comprehensive Infection Prevention and Control (IPC) prospective surveillance methodology was used to track SSIs. Patients were also followed using International Classification of Diseases, Tenth Revision (ICD-10) codes. We assessed the sensitivity/specificity and positive/negative predictive values of ICD-10 codes compared to IPC surveillance. RESULTS: Between April 1, 2012, and March 31, 2015, 24,512 people received hip/knee arthroplasty. Of these, 258 (1.05%) had a complex SSI found by IPC surveillance. Sensitivity and specificity of ICD-10 codes in identifying complex SSIs after hip/knee arthroplasty were 85.3% (95% confidence interval [CI] 80.3%-89.4%) and 99.5% (95% CI 99.4%-99.6%), respectively. Positive and negative predictive values were 63.6% (95% CI 58.3%-68.7%) and 99.8% (95% CI 99.8%-99.9%), respectively. DISCUSSION: Administrative data have reasonable testing characteristics for identifying complex SSIs after arthroplasty. For centers without prospective surveillance programs, this could be useful in identifying hospitals with frequent complex SSIs after arthroplasty. CONCLUSIONS: A comprehensive IPC surveillance program is superior at detecting SSIs after arthroplasty.