Work

Enhanced Identification of Postoperative Infections among Outpatients

Year: 2004

Type: article

Abstract: We investigated using administrative claims data to identify surgical site infections (SSI) after breast surgery and cesarean section.Postoperative diagnosis codes, procedure codes, and pharmacy information were automatically scanned and used to identify claims suggestive of SSI ("indicators") among 426 (22%) of 1,943 breast procedures and 474 (10%) of 4,859 cesarean sections.For 104 breast procedures with indicators explained in available medical records, SSI were confirmed for 37%, and some infection criteria were present for another 27%.Among 204 cesarean sections, SSI were confirmed for 40%, and some criteria were met for 27%.The extrapolated infection rates of 2.8% for breast procedures and 3.1% for cesarean section were similar to those reported by the National Nosocomial Infection Surveillance program but differ in representing predominantly outpatient infections.Claims data may complement other data sources for identification of surgical site infections following breast surgery and caesarian section.T he most commonly used methods for surgical site infection (SSI) surveillance are labor intensive, susceptible to variability, and relatively insensitive to SSI after hospital discharge (1-17).Automated diagnosis and treatment information created during routine healthcare delivery, if sufficiently accurate, could be used to improve SSI detection.Surveillance based on full-text electronic medical records has outperformed more widely used methods (18,19), but currently these records exist for a minority of procedures.Diagnosis, procedure, and pharmacy codes associated with insurance claims are widely available but provide less detailed information.Nevertheless, claims data after coronary artery bypass grafting (CABG) identified 45% more SSI than did traditional surveillance (20).Claims data also allowed comparison of infection rates between hospitals (21).We investigated the utility of claims data after breast surgery and cesarean section for infection surveillance; these procedures are among the most commonly performed.Assessing different procedure types is important because differences in the duration of hospitalization, inpatient management, postdischarge care, and practices in billing and reimbursement that underlie claims data may vary substantially among different types of procedures. Methods Breast Surgery Automated DataThe study population was drawn from three different administrative claims systems within Harvard Pilgrim Health Care from July 1997 through February 1999 and one system of Tufts Health Plan from January 1996 through February 1999.All members had benefits that would be expected to generate inpatient and outpatient diagnosis and procedure claims; 90% of members also had pharmacy benefits (unpub.data).Breast procedures were identified by International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) or Current Procedural Terminology (CPT) procedure codes (online Appendix 1 available from http://www.cdc.gov/ncidod/eid/vol10no11/04-0784_app1.htm).Breast surgeries were divided into the following four categories on the basis of expected infection risk: 1) limited procedures, including reduction mammoplasty, mastopexy without implant, and mastectomy without axillary dissection or reconstruction; 2) procedures that involve implants; 3) mastectomy with

Source: Emerging infectious diseases

DOI: 10.3201/eid1011.040784