Enhanced Identification of Postoperative Infections, Appendix

Past Issue

Vol. 10, No. 11
November 2004

Comments


•	Appendix Table 1
•	Appendix Table 2
•	Appendix Table 3
•	Appendix Table 4
•	Appendix Table 5
•	Appendix Table 6
•	Appendix Table 7
•	Appendix Table 8
•	Appendix Table 9
•	Appendix Table 10
•	Back to article

Research

Enhanced Identification of Postoperative Infections

Deborah S. Yokoe,* Gary A. Noskin,† Susan M. Cunningham,† Gianna Zuccotti,‡ Theresa Plaskett,‡ Victoria J. Fraser,§ Margaret A. Olsen,§ Jerome I. Tokars,¶ Steven Solomon,¶ Trish M. Perl,# Sara E. Cosgrove,# Richard S. Tilson,* Maurice Greenbaum,** David C. Hooper,†† Kenneth E. Sands,‡‡ John Tully,§§ Loreen A. Herwaldt,¶¶ Daniel J. Diekema,¶¶ Edward S. Wong,## Michael Climo,## and Richard Platt*^,***
*Brigham and Women's Hospital, Boston, Massachusetts, USA; †Northwestern University, Chicago, Illinois, USA; ‡Memorial Sloan-Kettering Cancer Center, New York, New York, USA; §Washington University School of Medicine, St. Louis, Missouri, USA; ¶Centers for Disease Control and Prevention, Atlanta, Georgia, USA; #Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; **North Shore Medical Center-Salem Hospital, Salem, Massachusetts, USA; ††Massachusetts General Hospital, Boston, Massachusetts, USA; ‡‡Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; §§Mount Auburn Medical Center, Cambridge, Massachusetts, USA; ¶¶University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; ##McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA; and ***Harvard Pilgrim Health Care, Boston, Massachusetts, USA

Appendix

Appendix Table 1. ICD-9-CM procedure and diagnosis codes to identify study procedures and screen diagnosis codes

ICD-9-CM codes	Description

Procedure codes
CABG
36.10–36.14	Aortocoronary bypass of coronary artery/arteries
36.15–36.17	Internal mammary-coronary artery bypass
36.19	Other bypass anastomosis for heart revascularization
36.2	Heart revascularization by arterial implant
Cesarean delivery
74.0–74.2, 74.4	Cesarean section (classical, low cervical, extraperitoneal, of other specified type)
74.9, 74.91, 74.99	Cesarean section of unspecified type
Breast procedures
85.23	Subtotal mastectomy
85.31–85.32	Reduction mammoplasty
85.33–85.36	Subcutaneous mammectomy
5.4, 85.41–85.48	Mastectomy (unilateral or bilateral, simple or radical)
5.50	Augmentation mammoplasty
5.53	Unilateral breast implant
5.54	Bilateral breast implant
5.6	Mastopexy
5.7	Total reconstruction of breast
Diagnosis codes	Description
998.5, 998.51, 998.59	Postoperative infection
674.32, 674.34	Other complications of obstetrical surgical wounds
670.02, 670.04	Major puerperal infection

^aICD-9-CM, International Classification of Diseases 9th Revision Clinical Modification; CABG, coronary artery bypass graft procedures.

Appendix Table 2. SSI rates^a after CABG procedures^b,c

Hospital	SSI rates based on (%)

	Routine surveillance	Any method (routine, antimicrobial exposure, discharge diagnoses)

1A	2.2	2.6
1B	2.3	3.5
1C	5.9	7.4
1D	7.7	9.9
Phase 1 pooled (SSI/procedures)	4.9 (112/2,267)	6.3 (142/2,267)
2A	2.4	6.1
2B	2.5	6.6
2C	3.5	6.0
2D	5.3	8.2
2E	6.1	9.6
2F	6.5	8.8
Phase 2 pooled (SSI/procedures)	4.6 (298/6,472)	7.7 (501/6,472)

^aThe numbers of SSI (surgical site infection) and procedures are not specified by hospital to maintain confidentiality of the hospitals' identities.
^bCABG, coronary artery bypass graft.
^cOn the basis of routine surveillance and routine surveillance plus antimicrobial exposure or diagnosis code screening.

Appendix Table 3. Sensitivity and positive predictive value of routine surveillance, and antimicrobial exposure screening using a 9-day antimicrobial interval or diagnosis code screening for identifying SSI after CABG procedures^a

Hospital	Sensitivity				Positive predictive value

	Routine surveillance	Antimicrobial exposure	Diagnosis codes	Antimicrobial exposure or diagnosis codes	Antimicrobial exposure	Diagnosis codes	Antimicrobial exposure or diagnosis codes

1A	85	75	45	75	33	75	14
1B	67	83	67	100	56	89	55
1C	80	82	57	84	47	86	47
1D	78	81	83	92	37	83	40
Pooled	0.79	0.80	0.61	0.87	0.33	0.86	0.35
2A	42	97	67	97	30	100	30
2B	41	100	78	100	35	78	33
2C	58	100	55	100	39	87	39
2D	65	92	57	95	33	89	33
2E	63	78	28	83	43	73	44
2F	74	100	53	100	39	77	39
Pooled	59	91	54	93	36	84	36

^aSSI, surgical site infections; CABG, coronary artery bypass graft.

Appendix Table 4. Percentage of patients who underwent CABG procedures and who met the antimicrobial exposure or diagnosis code screening criteria^a

Hospital	% of CABG patients with

	9-day antimicrobial threshold	7-day antimicrobial threshold	Diagnosis code criteria	9-day antimicrobial or diagnosis code criteria (%)

1A	13.7	–^b	2.2	13.8
1B	21.0	–^b	7.4	22.2
1C	12.9	–^b	4.9	13.2
1D	5.2	–^b	3.5	6.4
Pooled	15.2	–^b	4.5	15.8
2A	18.6	18.9	3.7	18.6
2B	17.3	21.0	6.2	18.2
2C	15.0	17.0	3.9	15.0
2D	22.9	31.5	5.3	23.6
2E	17.4	18.2	3.7	17.9
2F	22.6	25.3	6.0	22.6
Pooled	19.1	23.1	4.6	19.6

^aCABG, coronary artery bypass graft.
^b7-day antimicrobial threshold was not evaluated.

Appendix Table 5. SSI rates^a after cesarean delivery^b,c

Hospital	SSI rates (%)

	Routine surveillance	Any method (routine, antimicrobial exposure, diagnosis codes)

1A	2.2	3.8
1B	1.5	5.0
1C	0.9	2.7
1D	0.8	1.7
1E	5.3	6.4
Phase 1 pooled (SSI/procedures)	1.6 (43/2,659)	4.1 (110/2,659)
2A	0.3	3.7
2B	1.9	4.3
2C	NA	5.9
2D	NA	8.2
Phase 2 pooled (SSI/procedures)	1.6 (49/3,065)	5.5 (263/4,740)

^aThe numbers of SSI and procedures by hospital are not specified to maintain confidentiality of the hospitals' identities.
^bSSI, surgical site infection; NA, routine SSI surveillance for this procedure type was not performed at this hospital.
^cOn the basis of routine surveillance versus routine surveillance plus screening by antimicrobial exposure or diagnosis code criteria.

Appendix Table 6. Sensitivity and positive predictive value of routine surveillance and antimicrobial exposure screening^a

Hospital	Sensitivity (%)				Positive predictive value (%)

	Routine surveillance	Antimicrobial exposure	Diagnosis codes	Antimicrobial exposure or diagnosis code	Antimicrobial exposure	Diagnosis codes	Antimicrobial exposure or diagnosis code

1A	58	83	50	92	40	50	38
1B	30	94	48	98	52	73	52
1C	32	86	54	95	27	43	27
1D	50	100	0	100	20	0	20
1E	82	82	45	91	56	83	59
Phase 1 pooled	39	90	48	96	42	61	42
2A	9	87	100	100	45	49	39
2B	44	73	75	100	48	100	56
2C	NA	98	80	100	21	40	20
2D	NA	89	72	92	46	81	44
Phase 2 pooled	38	84	78	97	37	67	38

^aSSI, surgical site infections; NA, routine SSI surveillance for this procedure type was not performed at this hospital.
^bUsing a 2-day antimicrobial interval or diagnosis code screening for identifying SSI after cesarean delivery.

Appendix Table 7. Percentage of patients who underwent cesarean delivery and who met the antimicrobial exposure or diagnosis code screening criteria

Hospital	% of cesarean deliveries with

	2-day antimicrobial exposure criterion	Diagnosis code criteria	2-day antimicrobial exposure or diagnosis code criteria

1A	7.9	3.8	9.2
1B	9.1	3.3	9.4
1C	8.8	3.5	9.7
1D	8.5	0	8.5
1E	9.4	3.5	9.9
Pooled	8.8	3.2	9.5
2A	7.0	7.5	9.4
2B	6.5	3.3	7.7
2C	27.4	11.8	28.6
2D	20.0	9.2	21.2
Pooled	12.7	6.4	14.1

Appendix Table 8. SSI rates^a after breast procedures^b,c

Hospital	SSI rates (%)

	Routine surveillance	Any method (routine, antimicrobial, discharge diagnoses)

1A	0	0
1B	1.0	1.2
1C	1.2	2.1
1D	0	0
1E	0	0
1F	1.3	1.3
1G	0	0
Phase 1 pooled (SSI/procedures)	0.7 (10/1,477)	0.9 (14/1,477)
2A	0.3	1.6
2B	0.4	0.9
2C	NA	3.6
2D	NA	3.3
2E	NA	1.8
Phase 2 pooled (SSI/procedures)	0.4 (7/1,765)	2.3 (110/4,698)

^aThe numbers of SSI and procedures by hospital are not specified to maintain confidentiality of the hospitals' identities.
^bSSI, surgical site infection; NA, routine SSI surveillance for this procedure type was not performed at this hospital.
^cOn the basis of routine surveillance versus routine surveillance plus screening by antimicrobial exposure or diagnosis code criteria.

Appendix Table 9. Sensitivity and positive predictive value of routine surveillance and antimicrobial exposure screening^a,b

Hospital	Sensitivity (%)				Positive predictive value (%)

	Routine surveillance	Antimicrobial exposure	Diagnosis codes	Antimicrobial exposure and/or diagnosis codes	Antimicrobial exposure	Diagnosis codes	Antimicrobial exposure and/or diagnosis codes

1A	–	–	–	–	0	0	0
1B	83	50	50	50	60	100	60
1C	57	86	43	100	40	75	44
1D	–	–	–	–	0	–	0
1E	–	–	–	–	0	–	0
1F	100	100	100	100	33	100	33
1G	–	–	–	–	0	–	0
Pooled	71	71	50	79	19	58	20
2A	0	100	50	100	20	75	20
2B	50	100	42	100	33	45	33
2C	NA	92	75	92	38	56	34
2D	NA	95	82	100	37	96	38
2E	NA	80	40	100	29	62	27
Pooled	33	94	70	96	33	79	33

^aSSI, surgical site infection; NA, not applicable, –, no SSI identified at this hospital; NA, routine SSI surveillance for this procedure type was not performed at this hospital.
^bUsing a 6-day antimicrobial interval or diagnosis code screening for identifying SSI after breast procedures.

Appendix Table 10. Percentage of patients who underwent breast surgery and who met the antimicrobial or diagnosis code screening criteria

Hospital	% of breast surgery with

	6-day antimicrobial exposure criterion	Diagnosis code criteria	6-day antimicrobial exposure or diagnosis code criteria

1A	6.2	1.4	6.5
1B	1.0	0.6	1.0
1C	4.4	1.2	4.7
1D	1.5	0	1.5
1E	0	0	0
1F	3.8	1.3	3.8
1G	10.2	0	10.2
Pooled	3.5	0.8	3.7
2A	7.9	1.0	7.9
2B	2.6	0.8	2.6
2C	8.8	4.9	9.7
2D	8.5	2.8	8.7
2E	6.3	1.7	6.5
Pooled	6.7	2.0	6.8

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Deborah S. Yokoe, 181 Longwood Ave., Channing Laboratory, Boston, MA 02115, USA; fax: 617-731-1541; email: deborah.yokoe@channing.harvard.edu

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