Related Experiment Video
Updated: Nov 18, 2025
Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
Quantifying and interpreting inequality of surgical site infections among operating rooms
Franklin Dexter1, Richard H Epstein2, Randy W Loftus3
1Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa City, IA, 52242, USA. Franklin-Dexter@UIowa.edu.
Purpose:
The incidence of surgical site infection differs among operating rooms (ORs). However, cost effectiveness of interventions targeting ORs depends on infection counts. The purpose of this study was to quantify the inequality of infection counts among ORs.
Methods:
We performed a single-centre historical cohort study of elective surgical cases spanning a 160-week period from May 2017 to May 2020, identifying cases of infection within 90 days using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. We used the Gini index to measure inequality of infections among ORs. As a reference, the Gini index for inequality of household disposable income in the US in 2017 was 0.39, and 0.31 for Canada.
Results:
There were 3,148 (3.67%) infections among the 85,744 cases studied. The 20% of 57 ORs with the most and least infections accounted for 44% (99% confidence interval [CI], 36 to 52) and 5% (99% CI, 2 to 8), respectively. The Gini index was 0.40 (99% CI, 0.31 to 0.50), which is comparable to income inequality in the US. There were more infections in ORs with more minutes of cases (Spearman correlation ρ = 0.68; P < 0.001), but generally not in ORs with more total cases (ρ = 0.11; P = 0.43). Moderately long (3.3 to 4.8 hr) cases had a large effect, having greater incidences of infection, while not being so long as to have just one case per day per OR. There was substantially greater inequality in infection counts among the 557 observed combinations of OR specialty (Gini index 0.85; 99% CI, 0.81 to 0.88).
Conclusions:
Inequality of infections among ORs is substantial and caused by both inequality in the incidence of infections and inequality in the total minutes of cases. Inequality in infections among OR and specialty combinations is due principally to inequality in total minutes of cases.
Insights
Surgical site infection rates vary significantly across operating rooms (ORs). This inequality, measured by the Gini index, is substantial and linked to case duration and OR specialty, impacting cost-effectiveness of interventions.
Area of Science:
- Healthcare Management
- Infection Control
- Health Services Research
Background:
- Surgical site infections (SSIs) represent a significant healthcare burden, with incidence varying across different operating room (OR) environments.
- Understanding the distribution of SSIs is crucial for developing targeted and cost-effective infection control strategies.
- Previous research has highlighted variations in SSIs, but quantification of inequality among ORs is less explored.
Purpose of the Study:
- To quantify the inequality of surgical site infection counts among individual operating rooms.
- To assess the impact of case duration and OR specialty on infection inequality.
Main Methods:
- A single-center historical cohort study analyzed elective surgical cases over 160 weeks (May 2017-May 2020).
- Surgical site infections were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes within 90 days post-surgery.
- The Gini index was employed to measure the inequality of infection counts among ORs and OR-specialty combinations.
Main Results:
- Out of 85,744 cases, 3,148 (3.67%) resulted in SSIs.
- The Gini index for infection inequality among ORs was 0.40, comparable to US income inequality.
- Infections correlated positively with OR case minutes (Spearman ρ = 0.68) and were higher in moderately long cases (3.3-4.8 hours).
- Inequality was substantially greater for OR-specialty combinations (Gini index 0.85).
Conclusions:
- Significant inequality in surgical site infection counts exists among operating rooms.
- This inequality is driven by variations in infection incidence and total case minutes.
- Inequality is particularly pronounced in OR-specialty combinations, primarily due to unequal case minutes.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:25Interpreting Run Charts
01:28Asepsis