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Surveillance misses many SSIs after outpatient procedures
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Surveillance systems for surgical site infections, or SSIs, may exclude more than 50% of outpatient surgeries predicted to have an increased likelihood of an adverse event, based on data from more than two dozen Veterans Affairs facilities.
“Our prior work demonstrated that a substantial number of adverse events occur in outpatient surgeries, which are generally considered to be ‘safe’ and relatively low risk. We expanded upon this prior work by looking at the burden of surgical site infections following various ambulatory surgeries,” Katherine Linsenmeyer, MD, an infectious disease specialist with the Veterans Affairs Boston Healthcare System, told Infectious Disease News.
“Our goal,” Linsenmeyer continued, “was to measure how often infections occur in this setting, and if infections are occurring in places we would not expect — those procedures considered too low-risk for the standard surveillance process.”
Researchers conducted a retrospective study examining outpatient surgeries performed between Oct. 1, 2011, and Sept. 30, 2015, in 11 Veterans Affairs inpatient facilities and 20 VA freestanding ambulatory surgery centers, using data from the VA Corporate Data Warehouse.
“Outpatient surgeries included in the analysis were identified based on current procedure terminology (CPT) codes using the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Program’s 2014 Surgery Flag software,” Linsenmeyer and colleagues explained. “A VASQIP-eligible procedure was defined as an invasive procedure, identified by CPT code, associated with a measurable morbidity or mortality outcome. Eligible procedures were determined by the VA National Surgery Office.”
In total, 1,001,938 surgeries took place in the outpatient setting during the study period, of which 30% were VASQIP eligible. According to the study, the health care utilization flags used in the surveillance model flagged 6.4% of VASQIP-eligible cases and 8.7% of VASQIP-ineligible cases. The researchers manually reviewed 2,256 outpatient surgeries, of which 1,018 (45.1%) procedures were eligible for VASQIP review. Results showed that nearly all skin and soft tissue procedures (SSIs; 325 of 345, 95%) and nearly half of urologic procedures reviewed were not eligible for VASQIP surveillance. According to the study, 90 SSIs (4%) were identified among the manually reviewed cases and 47 SSIs (3.8%) were identified in the VASQIP-ineligible cases compared with 43 SSIs (4.5%) in the VASQIP-eligible cases.
Linsenmeyer summed up the findings, saying that more than half of the adverse events occurred in low-risk surgeries that do not meet criteria for review under current surveillance processes, which are based on clinician determination of invasiveness.
“Outpatient surgical procedures are increasing in complexity [and] our current surveillance systems for these procedures may not be sufficiently comprehensive to identify and address the full scope of safety concerns,” Linsenmeyer concluded. “Our study demonstrates the need to re-evaluate surveillance, particularly for surgical site infections, in this outpatient setting and to re-think how we classify ‘low’ and ‘high’ risk procedures — infections are a risk following any invasive procedure and it is important that we think about ways to implement effective inpatient prevention programs in outpatient settings.” – by Caitlyn Stulpin
Disclosures: Linsenmeyer reports no relevant financial disclosures. Please see the study for all other authors’ disclosures.
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