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Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation
V Merle1, J M Germain, P Chamouni
1Department of Epidemiology and Public Health, Rouen University Hospital-Charles Nicolle, Rouen, France.
Background:
The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections.
Aim Of The Study:
To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS.
Methods:
Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated.
Results:
The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor.
Conclusion:
Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.
Insights
Estimating hospital stay prolongation due to surgical site infections (SSIs) varies by method. The Appropriateness Evaluation Protocol (AEP) underestimated SSI impact compared to the matched-cohort study (MCS) method.
Area of Science:
- Healthcare Management
- Infectious Disease Epidemiology
- Surgical Outcomes Research
Background:
- Surgical site infections (SSIs) prolong hospital stays, with matched-cohort study (MCS) being the standard estimation method.
- MCS is prone to selection bias; the Appropriateness Evaluation Protocol (AEP) has not been validated for SSIs.
Purpose of the Study:
- To compare SSI-related hospital stay prolongation estimates using AEP versus MCS.
- To assess the validity of AEP for estimating stay prolongation caused by SSIs in digestive surgery.
Main Methods:
- Analyzed 65 SSIs in digestive tract surgery patients using both AEP and MCS.
- AEP calculated days appropriate for SSI care; MCS used matched controls to determine stay differences.
- Calculated AEP sensitivity, specificity, and agreement between AEP and MCS.
Main Results:
- Mean AEP stay prolongation was 3.5 days, significantly less than MCS's 7.2 days.
- AEP demonstrated 58% sensitivity and 75% specificity for estimating SSI-related stay prolongation.
- Agreement between AEP and MCS methods for estimating stay prolongation was poor.
Conclusions:
- SSIs following digestive surgery demonstrably increase hospital stay duration.
- The choice of estimation method significantly impacts the calculated prolongation of hospital stay for SSIs.