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Updated: Dec 22, 2025
Murine Excisional Wound Healing Model and Histological Morphometric Wound Analysis
Published on: August 21, 2020
An analysis of 3,954 cases to determine surgical wound classification accuracy: Does your institution need a monday
Sanjog Singh1, Sahitya Podila1, Grace Pyon1
1University of New Mexico Health Sciences Center, United States.
Introduction:
Surgical site infections reporting has financial implications for institutions under Centers for Medicare and Medicaid Services (CMS) Pay-for-Performance programs. Surgical Wound Classification (SWC) is an important factor in performing risk adjustment and affects the accuracy of the Standardized Infection Ratio (SIR). This in turn leads to more accurate inter-hospital ratings and reimbursement. This study aims to measure (1) services and procedures associated with the highest rates of misclassification and (2) whether temporal factors influenced misclassification.
Methods:
Accuracy of SWC was assessed by comparing the wound classification documented by the Operating Room (OR) nurse at the time of the operation to the actual SWC determined from in-depth chart review using Centers for Disease Control and Prevention (CDC) wound classification algorithm by a trained reviewer. Cases were reviewed once operative reports were available.
Results:
Review of 3954 cases yielded an overall discordance rate of 22.15% (N = 876), with most cases being under-classified. Services with the highest rates of discordance include cardiothoracic (38.46%) and general surgery (37.86%), followed by general oncology (29.46%), OB-GYN (28.93%), urology (27.27%), and plastic surgery (27.14%). Procedures with the highest discordance rates are laparoscopic appendectomy (66.67%), cholecystectomy (52.90%), exploratory laparotomy (49.21%), and split-thickness skin graft (36.84%). Discordance rates were significantly higher (p = 0.0001) during weekends compared to weekdays, while operations starting after-hours during the week did not show a significant difference from daytime hours.
Conclusion:
At a level 1 trauma academic medical center, certain procedures were found to be misclassified in regards to SWC more often than other types of cases. The timing of the case, such that they occurred on the weekends also contributed to higher discordance rates between original and corrected wound classifications. Recognizing cases, services, and temporal factors frequently associated with misclassification of wound class can help allocate limited resources to maximize improvement of this important metric.
Insights
Surgical Wound Classification (SWC) misclassification is common, especially in cardiothoracic and general surgery. Weekend surgeries significantly increase SWC errors, impacting hospital ratings and reimbursement.
Area of Science:
- Healthcare Quality Improvement
- Surgical Safety Metrics
- Medical Coding Accuracy
Background:
- Surgical site infections (SSIs) reporting impacts hospital finances through Centers for Medicare and Medicaid Services (CMS) Pay-for-Performance programs.
- Accurate Surgical Wound Classification (SWC) is crucial for risk adjustment and the Standardized Infection Ratio (SIR), affecting inter-hospital comparisons and reimbursement.
- Misclassification of SWC can lead to inaccurate performance metrics and financial penalties.
Purpose of the Study:
- To identify specific services and procedures with the highest rates of SWC misclassification.
- To determine if temporal factors, such as day of the week, influence SWC misclassification rates.
- To improve the accuracy of SSI reporting and financial reimbursement through better SWC.
Main Methods:
- Compared SWC documented by Operating Room (OR) nurses with classifications determined by trained reviewers using CDC criteria.
- Utilized in-depth chart reviews and operative reports for accuracy assessment.
- Analyzed 3954 cases to identify discordance rates and influencing factors.
Main Results:
- An overall SWC discordance rate of 22.15% was observed, with most cases under-classified.
- Cardiothoracic (38.46%) and general surgery (37.86%) services showed the highest misclassification rates.
- Weekend surgeries had significantly higher discordance rates (p=0.0001) compared to weekdays.
Conclusions:
- Certain procedures and services are more prone to SWC misclassification at academic medical centers.
- Weekend timing is a significant factor contributing to SWC discordance.
- Identifying and addressing factors leading to SWC misclassification is essential for resource allocation and improving quality metrics.
