Abstract
The system used by the National Nosocomial Infection Surveillance (NNIS) program to measure risk of surgical site infection uses a score of 3 on the American Society of Anesthesiologists (ASA)-physical status scale as a measure of underlying illness. The chronic disease score measures health status as a function of age, sex, and 29 chronic diseases, inferred from dispensing of prescription drugs. We studied the relationship between the chronic disease score and surgical site infection and whether the score can supplement the NNIS risk index. In a retrospective comparison of 191 patients with surgical site infection and 378 uninfected controls, the chronic disease score and ASA score were highly correlated. The chronic disease score improved prediction of infection by the NNIS risk index and augmented the ASA score for risk adjustment.
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Selected References
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- Boyce J. M., Potter-Bynoe G., Dziobek L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol. 1990 Feb;11(2):89–93. doi: 10.1086/646127. [DOI] [PubMed] [Google Scholar]
- Clark D. O., Von Korff M., Saunders K., Baluch W. M., Simon G. E. A chronic disease score with empirically derived weights. Med Care. 1995 Aug;33(8):783–795. doi: 10.1097/00005650-199508000-00004. [DOI] [PubMed] [Google Scholar]
- Cruse P. J., Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980 Feb;60(1):27–40. doi: 10.1016/s0039-6109(16)42031-1. [DOI] [PubMed] [Google Scholar]
- Cruse P. Wound infection surveillance. Rev Infect Dis. 1981 Jul-Aug;3(4):734–737. doi: 10.1093/clinids/3.4.734. [DOI] [PubMed] [Google Scholar]
- Cullen D. J., Apolone G., Greenfield S., Guadagnoli E., Cleary P. ASA Physical Status and age predict morbidity after three surgical procedures. Ann Surg. 1994 Jul;220(1):3–9. doi: 10.1097/00000658-199407000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Culver D. H., Horan T. C., Gaynes R. P., Martone W. J., Jarvis W. R., Emori T. G., Banerjee S. N., Edwards J. R., Tolson J. S., Henderson T. S. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S–157S. doi: 10.1016/0002-9343(91)90361-z. [DOI] [PubMed] [Google Scholar]
- Emori T. G., Culver D. H., Horan T. C., Jarvis W. R., White J. W., Olson D. R., Banerjee S., Edwards J. R., Martone W. J., Gaynes R. P. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control. 1991 Feb;19(1):19–35. doi: 10.1016/0196-6553(91)90157-8. [DOI] [PubMed] [Google Scholar]
- Garibaldi R. A., Cushing D., Lerer T. Risk factors for postoperative infection. Am J Med. 1991 Sep 16;91(3B):158S–163S. doi: 10.1016/0002-9343(91)90362-2. [DOI] [PubMed] [Google Scholar]
- Haley R. W., Culver D. H., White J. W., Morgan W. M., Emori T. G., Munn V. P., Hooton T. M. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985 Feb;121(2):182–205. doi: 10.1093/oxfordjournals.aje.a113990. [DOI] [PubMed] [Google Scholar]
- Haynes S. R., Lawler P. G. An assessment of the consistency of ASA physical status classification allocation. Anaesthesia. 1995 Mar;50(3):195–199. doi: 10.1111/j.1365-2044.1995.tb04554.x. [DOI] [PubMed] [Google Scholar]
- Owens W. D., Felts J. A., Spitznagel E. L., Jr ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978 Oct;49(4):239–243. doi: 10.1097/00000542-197810000-00003. [DOI] [PubMed] [Google Scholar]
- Poulsen K. B., Bremmelgaard A., Sørensen A. I., Raahave D., Petersen J. V. Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs. Epidemiol Infect. 1994 Oct;113(2):283–295. doi: 10.1017/s0950268800051712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Salemi C., Anderson D., Flores D. American Society of Anesthesiology scoring discrepancies affecting the National Nosocomial Infection Surveillance System: surgical-site-infection risk index rates. Infect Control Hosp Epidemiol. 1997 Apr;18(4):246–247. doi: 10.1086/647603. [DOI] [PubMed] [Google Scholar]
- Sands K., Vineyard G., Livingston J., Christiansen C., Platt R. Efficient identification of postdischarge surgical site infections: use of automated pharmacy dispensing information, administrative data, and medical record information. J Infect Dis. 1999 Feb;179(2):434–441. doi: 10.1086/314586. [DOI] [PubMed] [Google Scholar]
- Sands K., Vineyard G., Platt R. Surgical site infections occurring after hospital discharge. J Infect Dis. 1996 Apr;173(4):963–970. doi: 10.1093/infdis/173.4.963. [DOI] [PubMed] [Google Scholar]
- Vacanti C. J., VanHouten R. J., Hill R. C. A statistical analysis of the relationship of physical status to postoperative mortality in 68,388 cases. Anesth Analg. 1970 Jul-Aug;49(4):564–566. [PubMed] [Google Scholar]
- Von Korff M., Wagner E. H., Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol. 1992 Feb;45(2):197–203. doi: 10.1016/0895-4356(92)90016-g. [DOI] [PubMed] [Google Scholar]
- Wenzel R. P. Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control. Economic implications for hospitals under the prospective payment system. Am J Med. 1985 Jun 28;78(6B):3–7. doi: 10.1016/0002-9343(85)90356-0. [DOI] [PubMed] [Google Scholar]