Surgical Site and Clostridium difficile Infections after Ambulatory Surgery

描述（由申请人提供）：在美国，每年有超过1500万例外科手术在门诊手术中心（ASCs）进行。在美国，ASC手术占所有当日手术的40%以上；然而，目前几乎没有开展监测以确定与ASC手术相关的感染。关于手术部位感染（SSI）和抗生素耐药生物（如艰难梭菌）感染的发生率，在国家一级或个别机构进行ASC手术后的数据很少。在最近的一项CDC调查中发现，85%的被调查的ASCs存在推荐做法的缺陷，其中大多数涉及感染控制。有必要对与ASCs相关的感染进行研究。门诊手术后的感染监测需要整合医疗保健提供者和设施之间的信息。随着ASCs的扩散，必须开发可重复的方法来准确识别ASCs手术后的感染，以确定感染的临床和经济影响，并开发模型来预测个体患者的感染风险。为了实现这些目标，我们建议使用来自美国最大的商业保险人口的地理上不同的纵向医疗和药房索赔数据：1)确定保乳手术、疝修补和胆囊切除术（ASCs的三种常见手术）后艰难梭菌感染和SSI的发生率，包括耐甲氧西林金黄色葡萄球菌引起的感染；2)确定与SSI和艰难梭菌感染风险增加相关的设施和患者层面因素；3)利用患者层面的风险因素建立并验证风险预测模型。4)确定SSI和艰难梭菌感染的临床结果和归因成本。我们开发的识别感染的方法可作为国家监测asc相关感染的基础。这项研究将提供重要的新信息，以提高患者的安全性，并改善在门诊环境中接受普通外科手术的患者的预后。

DESCRIPTION (provided by applicant): Over 15 million surgical procedures are performed in ambulatory surgical centers (ASCs) in the U.S. annually. ASC procedures account for more than 40% of all same-day surgeries in the U.S.; however, virtually no surveillance is currently performed to identify infections associated with ASC procedures. There are very little data on the incidence of surgical site infection (SSI) and infection with antibiotic resistant organisms, such as Clostridium difficile, after ASC procedures at the national level or from individual facilities. In a recent CDC survey deficiencies in recommended practices were found in 85% of surveyed ASCs, most of which involved infection control. There is a need for research on infections associated with ASCs. Infection surveillance after ambulatory surgeries requires integration of information across healthcare providers and facilities. With the proliferation of ASCs it is essential to develop reproducible methods to accurately identify infections following surgical procedures commonly performed in ASCs to determine the clinical and economic impact of infection, and to develop models to predict the risk of infection in individual patients. To accomplish these goals we propose to use geographically diverse longitudinal medical and pharmacy claims data from the largest commercially insured population in the U.S. to: 1) determine the incidence of C. difficile infection and SSIs, including infections caused by methicillin-resistant Staphylococcus aureus, after breast conserving surgery, hernia repair, and cholecystectomy, three common procedures performed in ASCs, 2) identify facility- and patient-level factors associated with increased risk of SSI and C. difficile infection, 3) develop and validate risk prediction models using the patient-level risk factors, taking into account the specific types of surgical procedures, 4) determine clinical outcomes and attributable costs of SSI and C. difficile infection. The methods we develop to identify infections can be used as the basis for national surveillance of ASC-associated infections. This study will provide significant new information to enhance patient safety and improve outcomes for patients undergoing common surgical procedures in ambulatory settings. PUBLIC HEALTH RELEVANCE: We propose to determine rates and risk factors of surgical site and Clostridium difficile infections after surgical procedures performed in ambulatory settings. We will develop an algorithm to predict infections that can be used by providers prior to surgery to determine individual patients' risk of infection. This study will provide important new information that can be used to improve outcomes after common surgical procedures.