Accounting for Incomplete Postdischarge Follow-Up During Surveillance of Surgical Site Infection by Use of the National Nosocomial Infections Surveillance System's Risk Index
Accounting for Incomplete Postdischarge Follow-Up During Surveillance of Surgical Site Infection by Use of the National Nosocomial Infections Surveillance System's Risk Index
复制标题
DOI：
10.1086/596732
复制
发表时间：
2009-05-01
影响因子：
4.5
通讯作者：
Pedrosa, Tania M. G.
中科院分区：
文献类型：
--
作者：
Biscione, Fernando Martin;Couto, Renato Camargos;Pedrosa, Tania M. G.
目标。我们利用国家医院感染监测系统(NNIS)的风险指数，检验了在监测手术部位感染(SSI)期间，使用一种简单的方法来解释不完全出院后随访的有效性。设计：回顾队列研究，使用从1993年到2006年前瞻性收集的数据。设置巴西贝洛奥里藏特的五家私立、非大学医疗机构。连续接受以下NNIS手术程序的患者：20,981例在泌尿生殖系统手术，11,930例腹部子宫切除术，7,696例半子宫切除术，6,002例胆囊切除术，以及6,892例开腹手术。首先，指定了基于NNIS系统风险指数变量的模型(以下称为基于NNIS的模型)。其次，也基于NNIS系统的风险指数的修正模型(下称修正NNIS模型)指定了出院后监测指标，如果在随访期间可以联系到患者，则指定值1，如果无法联系到患者，指定值0。对两种模型评估SSI风险的能力进行了正式比较，方法是使用校准(通过皮尔逊拟合度检验)和判别(通过使用接收器操作特征曲线)。还计算了Goodman-Kruskal相关系数(G)。结果：出院后不完全随访率腹式子宫切除术29.8%，胆囊切除术50.5%。改良的基于NNIS的剖腹手术模型在任何方面都没有显示出比基于NNIS的模型有任何显著的益处。在所有其他手术过程中，与基于NNIS的模型相比，改进的基于NNIS的模型显示出显著改善的判别能力和更高的G统计量，除了用于评估泌尿生殖系统手术或胆囊切除术后SSI的风险外，在校准方面没有明显的损害。结论与基于NNIS的模型相比，改进的基于NNIS的模型增加了关于大多数手术过程的潜在有用的临床信息。对于SSI监测期间不完全的出院后随访，有必要对该方法进行进一步的评估。
OBJECTIVE. We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index.DESIGN. Retrospective cohort study that used data prospectively collected from 1993 through 2006.SETTING. Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil.PATIENTS. Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 hemiorraphies, 6,002 cholecystectomies, and 6,892 laparotomies.METHODS. For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated.RESULTS. The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations on the genitourinary system or after a cholecystectomy.CONCLUSIONS. Compared with the NNIS-based model, the modified NNIS-based model added potentially useful clinical information regarding most of the operative procedures. Further work is warranted to evaluate this method for accounting for incomplete postdischarge follow-up during surveillance of SSI.