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Surg Infect (Larchmt). 2019 Apr;20(3):225-230. doi: 10.1089/sur.2018.211. Epub 2019 Jan 18.

Comparison of Surveillance of Surgical Site Infections by a National Surveillance Program and by Institutional Audit.

Author information

1
1 Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland.
2
2 Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland.
3
3 Department of Hospital Preventive Medicine, Lausanne University HospitalCHUV, Lausanne, Switzerland.
4
4 Department of Medicine and Visceral Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND:

Reported incidence of surgical site infections (SSI) after colonic surgery varies widely. These variations depend not only on patient- and surgery-related parameters but are influenced by type and quality of follow-up. The aim of the study was to compare SSI assessed by two independent prospective surveillance systems, a national surveillance program based on recommendations of the National Healthcare Safety Network (Swissnoso) versus an international audit system, the ERAS® Interactive Audit System (EIAS; Encare, Stockholm, Sweden).

METHODS:

Comparative study of a consecutive cohort of colonic resections at a single institution from September 2015 to March 2017. Independent prospective SSI monitoring was available from Swissnoso and EIAS. Inter-observer reliability was calculated using Cohen k. Sensitivity, specificity, and accuracy of EIAS in assessing SSI was compared with Swissnoso, considered as gold standard.

RESULTS:

The final sample included 143 patients. Of these, 136 (95.1%) were classified into the same category by both systems, identifying 17 patients (12.5%) with SSI and 119 patients (87.5%) without SSI, respectively. Discrepant results were found for the remaining seven patients (4.9%) with four SSI categorization according to Swissnoso but not EIAS, and three SSI categorization in EIAS but not in Swissnoso; all miscategorized patients presented superficial SSI. Sensitivity, specificity, and accuracy of EIAS for SSI recording was 81%, 97.5%, and 95.1%, respectively. Inter-observer agreement was high (Cohen k value of 0.801, p < 0.001). Case-by-case analysis of discrepant findings revealed mainly discrepant interpretation of clinical symptoms and erroneous labeling of non-procedure-related infections.

CONCLUSIONS:

Surgical site infection recording by two independent systems showed high concordance and good inter-rater reliability.

KEYWORDS:

colonic surgery; enhanced recovery; surgical site infection; surveillance

PMID:
30657425
DOI:
10.1089/sur.2018.211
[Indexed for MEDLINE]

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