Surgical Site Infections

Volume-Outcome Relationship and Year-to-Year Stability of Performance Rankings

Bibliographic Data

ID9101890
AuthorsMichael S Calderwood (0000-0002-3803-0438, Division of Infectious Diseases, Brigham and Women’s Hospital, corresponding author), Kim Kleinman (0000-0002-5600-5834, University of Massachusetts Amherst), Ken Kleinman (Department of Biostatistics and Epidemiology, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA), Susan S Huang (0000-0001-6748-3447, Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, CA), Michael Murphy (0000-0001-8458-3992, Harvard University), Michael V Murphy (Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston), Deborah S Yokoe (Division of Infectious Diseases, Brigham and Women’s Hospital, corresponding author), Richard Platt (0000-0002-3248-3583, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston)
Year2017
Volume55
Issue1
Pages79-85
Publication date2017-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000620
PMID27517331
OpenAlexW2518021738
LanguageEN
References cited26

BACKGROUND: Surgical site infection (SSI) rates are publicly reported as quality metrics and increasingly used to determine financial reimbursement. OBJECTIVE: To evaluate the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. RESEARCH DESIGN: We performed a retrospective cohort study of Medicare beneficiaries who underwent CABG surgery or hip arthroplasty at US hospitals from 2005 to 2011, with outcomes analyzed through March 2012. Nationally validated claims-based surveillance methods were used to assess for SSI within 90 days of surgery. The relationship between procedure volume and SSI rate was assessed using logistic regression and generalized additive modeling. Year-to-year stability of SSI rates was evaluated using logistic regression to assess hospitals' movement in and out of performance rankings linked to financial penalties. RESULTS: Case-mix adjusted SSI risk based on claims was highest in hospitals performing <50 CABG/year and <200 hip arthroplasty/year compared with hospitals performing ≥200 procedures/year. At that same time, hospitals in the worst quartile in a given year based on claims had a low probability of remaining in that quartile the following year. This probability increased with volume, and when using 2 years' experience, but the highest probabilities were only 0.59 for CABG (95% confidence interval, 0.52-0.66) and 0.48 for hip arthroplasty (95% confidence interval, 0.42-0.55). CONCLUSIONS: Aggregate SSI risk is highest in hospitals with low annual procedure volumes, yet these hospitals are currently excluded from quality reporting. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance

Arthroplasty · Confidence interval · Health care · Hip Arthroplasty · Logistic regression · Medicaid · Quartile · Reimbursement · Retrospective cohort study · Emergency Medicine · Internal Medicine · Medicine · Orthopedic Infections and Treatments · Pancreatic and Hepatic Oncology Research · Surgery · Surgical site infection prevention

Tools

Open DOISci-HubOpen Access