Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safely Network

TLDR

NHSN has provided simple risk adjustment for surgical site infection rates, and this study developed and evaluated improved procedure‑specific risk models using NHSN data from 2006‑2008. The authors analyzed 849,659 procedures from 847 hospitals, restricted to primary incision SSIs, and used univariate screening followed by stepwise logistic regression to build procedure‑specific models, validated by bootstrap resampling and compared via c‑index to the NHSN risk index model. The new procedure‑specific models achieved higher predictive accuracy (median c‑index 0.67 vs 0.60) than the NHSN risk index, with 33 of 39 procedures showing improved performance, demonstrating that existing NHSN data can enhance SSI risk prediction.

Abstract

The National Healthcare Safety Network (NHSN) has provided simple risk adjustment of surgical site infection (SSI) rates to participating hospitals to facilitate quality improvement activities; improved risk models were developed and evaluated.Data reported to the NHSN for all operative procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Only SSIs related to the primary incision site were included. A common set of patient- and hospital-specific variables were evaluated as potential SSI risk factors by univariate analysis. Some ific variables were available for inclusion. Stepwise logistic regression was used to develop the specific risk models by procedure category. Bootstrap resampling was used to validate the models, and the c-index was used to compare the predictive power of new procedure-specific risk models with that of the models with the NHSN risk index as the only variable (NHSN risk index model).From January 1, 2006, through December 31, 2008, 847 hospitals in 43 states reported a total of 849,659 procedures and 16,147 primary incisional SSIs (risk, 1.90%) among 39 operative procedure categories. Overall, the median c-index of the new procedure-specific risk was greater (0.67 [range, 0.59-0.85]) than the median c-index of the NHSN risk index models (0.60 [range, 0.51-0.77]); for 33 of 39 procedures, the new procedure-specific models yielded a higher c-index than did the NHSN risk index models.A set of new risk models developed using existing data elements collected through the NHSN improves predictive performance, compared with the traditional NHSN risk index stratification.