Comparing surgical infections in National Surgical Quality Improvement Project and an institutional database Journal Article


Authors: Selby, L. V.; Sjoberg, D. D.; Cassella, D.; Sovel, M.; Weiser, M. R.; Sepkowitz, K.; Jones, D. R.; Strong, V. E.
Article Title: Comparing surgical infections in National Surgical Quality Improvement Project and an institutional database
Abstract: Background Surgical quality improvement requires accurate tracking and benchmarking of postoperative adverse events. We track surgical site infections (SSIs) with two systems; our in-house surgical secondary events (SSE) database and the National Surgical Quality Improvement Project (NSQIP). The SSE database, a modification of the Clavien-Dindo classification, categorizes SSIs by their anatomic site, whereas NSQIP categorizes by their level. Our aim was to directly compare these different definitions. Materials and methods NSQIP and the SSE database entries for all surgeries performed in 2011 and 2012 were compared. To match NSQIP definitions, and while blinded to NSQIP results, entries in the SSE database were categorized as either incisional (superficial or deep) or organ space infections. These categorizations were compared with NSQIP records; agreement was assessed with Cohen kappa. Results The 5028 patients in our cohort had a 6.5% SSI in the SSE database and a 4% rate in NSQIP, with an overall agreement of 95% (kappa = 0.48, P < 0.0001). The rates of categorized infections were similarly well matched; incisional rates of 4.1% and 2.7% for the SSE database and NSQIP and organ space rates of 2.6% and 1.5%. Overall agreements were 96% (kappa = 0.36, P < 0.0001) and 98% (kappa = 0.55, P < 0.0001), respectively. Over 80% of cases recorded by the SSE database but not NSQIP did not meet NSQIP criteria. Conclusions The SSE database is an accurate, real-time record of postoperative SSIs. Institutional databases that capture all surgical cases can be used in conjunction with NSQIP with excellent concordance. © 2015 Elsevier Inc.
Keywords: adult; major clinical study; cohort analysis; total quality management; surgical infection; postoperative infection; surgical site infection; surgical complications; clinical classification; human; male; female; priority journal; article; secondary event grading system; surgical quality improvement; surgical secondary events; wound classification; incisional infection
Journal Title: Journal of Surgical Research
Volume: 196
Issue: 2
ISSN: 0022-4804
Publisher: Academic Press Inc., Elsevier Science  
Date Published: 2015-06-15
Start Page: 416
End Page: 420
Language: English
DOI: 10.1016/j.jss.2015.02.072
PROVIDER: scopus
PUBMED: 25840487
PMCID: PMC4667735
DOI/URL:
Notes: Export Date: 2 July 2015 -- Source: Scopus
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MSK Authors
  1. Kent A Sepkowitz
    247 Sepkowitz
  2. Martin R Weiser
    346 Weiser
  3. Daniel D. Sjoberg
    141 Sjoberg
  4. Vivian Strong
    148 Strong
  5. Mindy Sovel
    5 Sovel
  6. David Randolph Jones
    153 Jones
  7. Luke   Selby
    19 Selby