New York State (NYS) mandated reporting of colon surgical site infection rates beginning on January 1, 2007. Surgical site infections (SSIs) associated with colon surgical procedures were chosen for surveillance due to the number of surgeries performed, frequency and severity of infections, potential for risk adjustment and quality improvement.
Evaluate the incidence and risk factors for colon surgical site infections in 2007 and 2008.
NYS chose to use the National Healthcare Safety Network (NHSN) for HAI reporting. NYS rates were compared to 2006-2007 National rates, the most recent published data; and NYS hospital-specific rates to NYS average rates, stratified by risk category. In addition to NHSN risk factors, many other possible risk factors were assessed including: transfusion; cancer; trauma; emergency; obesity; diabetes; enteritis; diverticulitis; and type of procedure. Risk factor information was obtained from administrative (discharge) data sources or the NHSN, when available.
Results: 178 hospitals reported colon surgery data. NYS colon SSI rates were lower in 2008 than national colon SSI rates reported for 2006-2007. The differences were statistically significant in all but the lowest risk group. The 2008 NYS colon SSI rates were significantly lower than 2007 NYS colon SSI rates.
12 hospitals had rates that were statistically lower than the state average, while 9 had rates that were statistically higher than the state average. Forty-two (24%) hospitals reported 0 colon SSIs in 2008 (procedures performed 20 to 168). There was no association between SSI rates and the number of procedures performed.
Patients requiring a transfusion had statistically higher rates of infection, although the addition of this information did not improve the risk adjustment model. Given the source of this data, the Department could not ascertain whether the transfusions were required by the patient prior to, during or after their surgery. None of the other possible risk factors evaluated significantly affected adjusted rates of infection.
With two years of NYS colon SSI data complete, there appears to be improvements in rates across risk categories and facilities. As more data becomes available, NYS will better be able to systematically evaluate the possible impacts of mandatory public reporting on colon surgical site infection rates.
The full 2007 and 2008 reports can be found at: www.nyhealth.gov/nysdoh/hospital/reports/hospital_acquired_infections.