11 Oct ID Week: Lower Surgical Volume May Mean Higher Infection Risk

MedicalResearch.com Interview with:
Michael S. Calderwood, MD MPH
Division of Infectious Diseases
Brigham and Women’s Hospital
Boston, MA

Medical Research: What are the main findings of the study?

Dr. Calderwood: “In our study, we found that the risk of surgical site infection (SSI) following total hip arthroplasty and coronary artery bypass graft (CABG) surgery is higher for Medicare patients undergoing surgery in U.S. hospitals with lower surgical volume. This suggests that volume leads to experience, and experience leads to improved outcomes.”

“We found a significantly higher risk of surgical site infection in U.S. hospitals performing <100 total hip arthroplasty procedures and <50 CABG procedures per year on Medicare patients. In the lowest volume hospitals, 1 out of 3 infections following total hip arthroplasty and 1 out of 4 infections following CABG were in excess of expected outcomes based on experience in the highest volume hospitals.”

Medical Research: What was most surprising about the results?

Dr. Calderwood: “A large proportion of U.S. hospitals fall into these low volume, higher risk groups. 72% of U.S. hospitals perform <100 total hip arthroplasty procedures and 28% of U.S. hospitals perform <50 CABG procedures per year on Medicare patients. Our data suggests that these hospitals have a significantly higher risk of surgical site infection.”

“At present, however, many U.S. hospitals are excluded from being compared to national benchmarks for healthcare-associated infections (HAIs) due to low volumes of device days, patient days, or surgical procedures. If you look at the 6 HAIs publicly reported on Medicare’s Hospital Compare website, 16-73% of U.S. hospitals do not have their performance compared to national benchmarks. This is also true on many state report cards comparing hospital HAIs.”

Medical Research: What should clinicians and patients take away from your report?

Dr. Calderwood: “Clinicians and patients should understand the limitations of our current publicly reported data. U.S. hospitals with low surgical volume are excluded from public reporting but have higher rates of surgical site infection.”

Dr. Calderwood: What recommendations do you have for future research as a result of this study?

Dr. Calderwood: “We need to identify and validate methods to compare surgical site infection performance for hospitals performing a lower volume of procedures, rather than just ignoring these hospitals in our public reporting.”

Citation:

2014 ID Week abstract:

U.S. Hospitals with Low Surgical Volume are Excluded from Public Reporting but have Higher Rates of Surgical Site Infection
Session: Oral Abstract Session: Advancing Public Reporting and Surveillance of Healthcare-associated Infections

Last Updated on October 11, 2014 by Marie Benz MD FAAD