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Algorithm using coding systems may identify surgical site infections in spinal surgery
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Investigators using a combination of administrative claims data to study patients who underwent spinal surgeries at a high-volume center discovered a 2.6% rate of surgical site infection and identified risk factors that were significantly associated with infection.
“The algorithm that we have proposed is accurate and useful in identifying the cases with infection as well as risk factors for infection,” Sigurd H. Berven, MD, director of spine fellowship and resident education in the department of orthopedic surgery at the University of California, San Francisco, said during his presentation at the International Society for the Study of the Lumbar Spine Annual Meeting 2011.
Coding systems used
Using the Diagnosis-Related Group, Current Procedural Terminology and the International Classification of Disease-9 codes, Berven and colleagues identified 2,135 patients who underwent spine surgery performed by nine orthopedic and neurosurgeons at a single, tertiary care center during a 1-year period. The investigators validated the claims by performing a chart review.
They found a 2.6% cumulative rate of surgical site infections.
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“The mean hospital length of stay was twice as long for people who had an infection than those who did not, and there was a trend toward an increased rate of infection with age,” Berven said.
Factors linked to infection
Patient-based factors that were significantly associated with an increased risk of infection included obesity, anemia and a diagnosis of tumor. Procedural-based factors that the investigators found to be significantly associated with higher odds of infection included fusion of more than seven levels, fusion extending to the sacrum, autologous transfusion, operative time of more than 5 hours and more than 2 weeks of hospitalization.
“Using a multivariate analysis, we found that tumor, more than eight levels of surgery and fixation to the pelvis were associated with a higher risk of infection, and single-level surgeries and anterior approaches were associated with a lower risk of infection,” Berven said.
He noted that complication rates, including infection, are important measures of quality of care.
“It is also important to accurately identify the diagnosis, the procedure and the complexity [of surgery],” Berven said. “Right now, existing systems do not capture many of the risk factors that predict the possibility of infection. I think that including more parameters — including procedure codes and diagnostic codes — allows us to be more granular in identifying our cases and allows us to identify risk factors more accurately so that we can stratify cases appropriately.” – by Gina Brockenbrough, MA
Reference:
- Berven S, Abdul-Jabbar A, Weber MH, et al Surgical site infection in spinal surgery: Clinical application of administration claims data. Paper #P69. Presented at the International Society for the Study of the Lumbar Spine Annual Meeting 2011. June 14-18. Gothenburg, Sweden.
- Sigurd H. Berven, MD, can be reached at 500 Parnassus Ave., MU320W, San Francisco, CA 94143-0728; 415-514-2064; email: bervens@orthosurg.ucsf.edu.
- Disclosure: Berven has no relevant financial disclosures.