Surgical Site Infection Trend Analysis Following Colon Surgeries, National Healthcare Safety Network, 2009–2018

Abstract

Background: Hospitals have submitted surveillance data for surgical site infections (SSIs) following colon surgeries (COLO) to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) since 2005. COLO SSI data submissions to NHSN have increased substantially beginning in 2012 as result of a Centers for Medicare and Medicaid Services (CMS) mandatory reporting requirement that began that year. A trend analysis of COLO SSIs, using data submitted to NHSN, has not been previously reported. To estimate the national trend of COLO SSI rates, we analyzed data reported from acute-care hospitals during 2009–2018. Methods: We analyzed inpatient adult COLO procedures with primary closure and resulting deep incisional primary and organ-space SSIs detected during the same hospitalization or rehospitalization in the same hospital. SSIs reported as infection present at time of surgery (PATOS) were included in the analysis. A protocol change that reprioritized COLO above small bowel surgery (SB) in the multiprocedural abdominal operations selection list for SSI attribution beginning in 2013 was a potential interruption to COLO SSI outcome. An interrupted time series with mixed-effects logistic regression was used to estimate the annual change in the log odds of COLO SSI. The estimates were adjusted for the following variables: hospital bed size, gender, emergency, trauma, general anesthesia, scope, ASA score, wound classification, medical school affiliation type, procedure duration and age. We also assessed the slope and level change of log odds before and after 2013. Results: The number of hospitals and procedures increased and then stabilized after 2012 (Table 1). The annual crude SSI rates ranged from 2.40% to 3.10%. There was no statistically significant slope change in 2013 and after. Compared to 2009–2012, the log odds of COLO SSI increased in 2013–2018 (OR, 1.1975; P < .0001). Based on this model, we estimate a 0.58% annual decrease in the odds of having a COLO SSI during 2009–2012 and 2013–2018 after controlling for the aforementioned variables (Table 2). Conclusions: We observed a substantial increase in the volume of hospitals and procedures reported to the NHSN since 2012 and an increase in odds of having a COLO SSI in 2013–2018 associated with surveillance protocol changes. After adjusting for these changes, we found a slight annual decrease in the overall odds of COLO SSI. Greater prevention efforts are needed for COLO SSI.

Funding: None

Disclosures: None