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Risk Adjustment for Determining Surgical Site Infection in Colon Surgery: Are All Models Created Equal?

Sydne Muratore1, Catherine Statz1, J J Glover1

  • 1Department of Surgery, University of Minnesota , Minneapolis, Minnesota.

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This summary is machine-generated.

The Centers for Medicare and Medicaid Services (CMS) model predicts lower colon surgical site infection (SSI) rates than the National Healthcare Safety Network (NHSN) model. This discrepancy may impact hospital reimbursement due to differing risk adjustment factors.

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Area of Science:

  • Healthcare quality measurement
  • Infection control
  • Surgical outcomes analysis

Background:

  • Colon surgical site infections (SSIs) are critical quality indicators for hospital reimbursement and public reporting.
  • The Centers for Medicare and Medicaid Services (CMS) mandate colon SSI reporting via the National Healthcare Safety Network (NHSN).
  • Discrepancies exist between CMS and NHSN risk adjustment models for expected SSIs.

Purpose of the Study:

  • To compare the expected colon SSI rates predicted by the CMS risk-adjustment model versus the NHSN model.
  • To evaluate the impact of differing risk adjustment variables on standardized infection ratios (SIRs).

Main Methods:

  • Prospective collection of colon SSI data from six Fairview Hospitals (2012-2014, 1,789 procedures).
  • Comparison of expected SSIs and SIRs using CMS (age, ASA) and NHSN (age, ASA, procedure duration, endoscope use, medical school affiliation, hospital bed number, incision class) risk-adjustment models.

Main Results:

  • The CMS model predicted significantly lower expected quarterly SSIs compared to the NHSN model across all Fairview Hospitals.
  • This difference was consistent in both university and community-based hospital settings.
  • CMS identified potential outlier SIRs for complex colon SSIs in two quarters, which NHSN did not flag.

Conclusions:

  • The CMS risk-adjustment model, using limited factors like age and ASA classification, underestimates expected colon SSI rates compared to the more comprehensive NHSN model.
  • This underestimation could lead to unwarranted financial penalties for hospitals.
  • Further research is needed to refine risk adjustment measures for colon SSIs, balancing accuracy with data collection burden.