ABSTRACT: The National Nosocomial Infection Surveillance System (NNIS) has historically provided the infection control community with the most accurate benchmark for healthcare-associated infections. However, NNIS does not require postdischarge surveillance. For medical centers where comprehensive postdischarge surveillance is possible, the efficiency of surgical site infection (SSI) detection is enhanced and rates may be higher than those provided by NNIS.
From 1999 to 2004, a large integrated healthcare system (IHCS) used a standard surveillance methodology inclusive of the postdischarge period. This article compares IHCS and NNIS SSI data.
IHCS infection rates, stratified and weighted average (hip, 1.7; knee, 2.1) for the study period are higher than the corresponding NNIS rates (hip, 1.4; knee, 1.2) (hip, P = .006; knee, P = .012) when infections detected by the IHCS during the postdischarge period are included.
The data from the study period show that when comprehensive postdischarge surveillance is used by the IHCS, SSI rates are higher than those reflected in the NNIS database.
American Journal of Infection Control 01/2007; 34(10):669-72. · 2.40 Impact Factor
ABSTRACT: Dislocation rates after total hip arthroplasty in a community setting have not been well documented. We used a community based joint registry to evaluate hip dislocations that occurred within 1 year after total hip arthroplasty. We evaluated patient, implant, and technical factors associated with dislocation, including primary versus revision surgery, femoral head size (28 mm versus > or = 32 mm), operative time, surgeon volume, surgical approach, age, gender, diagnosis, American Society of Anesthesiologists (ASA) classification, and body mass index (BMI). There were 1693 primary total hip arthroplasties and 277 revision procedures performed from 2001-2003. The overall dislocation rate was 1.7% for primary total hip arthroplasties and 5.1% for revision procedures. Patients with ASA scores of 3 or 4 had a 2.3-fold dislocation increase compared with patients with scores of 1 or 2. Patients with rheumatoid arthritis had an increased risk of dislocation. The dislocation rates for primary total hip arthroplasty were 2% for 28 mm heads and 0.7% for heads > or = 32 mm. The surgeon's patient volume, surgical approach, operative time, and body mass index had no effect on dislocation.
Clinical Orthopaedics and Related Research 06/2006; 447:19-23. · 2.53 Impact Factor
ABSTRACT: Variation in readmission rates, length of stay, and operative time associated with rotator cuff surgery should be understood if cost-control strategies are to be considered. We hypothesized that there would be variation in resource utilization as measured in terms of these factors and that surgeon and hospital practice patterns, rather than patient characteristics, would explain this variation.
We conducted a retrospective analysis of the effects of surgeon, hospital, and patient-related factors on the readmission rates, length of stay, and operative time associated with 1077 rotator cuff repairs performed by thirty-two surgeons in eleven group-model health maintenance organization hospitals, two satellite centers, and one contract facility in southern California.
The initial unadjusted analysis of covariance showed moderate-to-strong associations between surgeon and hospital variation and the rate of hospital readmission within thirty days (p = 0.0919 and p = 0.0209, respectively), extended length of stay (p = 0.0016 and p = 0.0016, respectively), and operative time (p < 0.0001 and p < 0.0001, respectively). The hospital effect was no longer significant when patient-related factors (i.e., sociodemographic characteristics and comorbidities) and the surgeon effect were taken into account. The surgeon effect was still significant (except with regard to the readmission rate) after adjustment for patient and hospital-related factors, explaining 23% of the variation in length of stay and 69% of the variation in operative time. There was a significantly increased risk of an extended stay (p = 0.0010) and readmission (p = 0.0260) following procedures performed at hospitals with an orthopaedic residency program. Increased operative time was significantly associated with decreased surgeon volume (p < 0.0001) and the absence of an orthopaedic residency program (p < 0.0001).
Variation in length of stay and operative time associated with rotator cuff surgery is largely explained by surgeon practice patterns. Our results suggest that surgeons have the ability to affect these two factors, which are often identified as drivers of cost.
The Journal of Bone and Joint Surgery 09/2003; 85-A(9):1784-9. · 3.27 Impact Factor