Focusing on surgical site infection care pathways; An international US-UK comparison using The American College of Surgeons National Surgical Quality Improvement Program.
Association of Breast Surgery ePoster Library. Che Bakri N. 05/15/17; 166175; P081
Nur Amalina Che Bakri
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Abstract
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Background: St Mary's Hospital was one of the first international pilot sites for ACS-NSQIP. A quarterly report showed higher risk-adjusted rates of surgical site infection for general and vascular surgery than those reported in participating US hospitals.
Aim: To examine preventative practices for SSI, post-operative management and diagnosis in patients in a hospital in the UK and US in order to understand the potential gains and pitfalls in using a clinical registry such as NSQIP to evaluate care in two different countries.
Methods: NSQIP data for 100 consecutive patients diagnosed with surgical site infection from one US hospital and 83 from one UK hospital between 2011-2013 were retrieved. Additional clinical information from hospital records was collected retrospectively, to include pre-operative, perioperative and post-operative process measures for SSI prevention, as well as differences in post-discharge diagnosis and healthcare utilization.
Results: 98 and 80 correct diagnoses of SSI in the US and UK respectively were reviewed. Significant pre-operative preventative practice differences were observed as well as post-discharge management.
Conclusion: ACS-NSQIP identified St Mary's hospital in the UK as an outlier for surgical site infection. The reasons for this are multifactorial, including different peri-operative and intra-operative technical processes, which may reflect genuine differences in the quality of care provided, or the quality of the underlying data. The reliability of post-discharge diagnoses is questionable, with more SSIs diagnosed and managed by primary care physicians in the UK and more patients in the US with immediate access to the lead surgical team.
Aim: To examine preventative practices for SSI, post-operative management and diagnosis in patients in a hospital in the UK and US in order to understand the potential gains and pitfalls in using a clinical registry such as NSQIP to evaluate care in two different countries.
Methods: NSQIP data for 100 consecutive patients diagnosed with surgical site infection from one US hospital and 83 from one UK hospital between 2011-2013 were retrieved. Additional clinical information from hospital records was collected retrospectively, to include pre-operative, perioperative and post-operative process measures for SSI prevention, as well as differences in post-discharge diagnosis and healthcare utilization.
Results: 98 and 80 correct diagnoses of SSI in the US and UK respectively were reviewed. Significant pre-operative preventative practice differences were observed as well as post-discharge management.
Conclusion: ACS-NSQIP identified St Mary's hospital in the UK as an outlier for surgical site infection. The reasons for this are multifactorial, including different peri-operative and intra-operative technical processes, which may reflect genuine differences in the quality of care provided, or the quality of the underlying data. The reliability of post-discharge diagnoses is questionable, with more SSIs diagnosed and managed by primary care physicians in the UK and more patients in the US with immediate access to the lead surgical team.
Background: St Mary's Hospital was one of the first international pilot sites for ACS-NSQIP. A quarterly report showed higher risk-adjusted rates of surgical site infection for general and vascular surgery than those reported in participating US hospitals.
Aim: To examine preventative practices for SSI, post-operative management and diagnosis in patients in a hospital in the UK and US in order to understand the potential gains and pitfalls in using a clinical registry such as NSQIP to evaluate care in two different countries.
Methods: NSQIP data for 100 consecutive patients diagnosed with surgical site infection from one US hospital and 83 from one UK hospital between 2011-2013 were retrieved. Additional clinical information from hospital records was collected retrospectively, to include pre-operative, perioperative and post-operative process measures for SSI prevention, as well as differences in post-discharge diagnosis and healthcare utilization.
Results: 98 and 80 correct diagnoses of SSI in the US and UK respectively were reviewed. Significant pre-operative preventative practice differences were observed as well as post-discharge management.
Conclusion: ACS-NSQIP identified St Mary's hospital in the UK as an outlier for surgical site infection. The reasons for this are multifactorial, including different peri-operative and intra-operative technical processes, which may reflect genuine differences in the quality of care provided, or the quality of the underlying data. The reliability of post-discharge diagnoses is questionable, with more SSIs diagnosed and managed by primary care physicians in the UK and more patients in the US with immediate access to the lead surgical team.
Aim: To examine preventative practices for SSI, post-operative management and diagnosis in patients in a hospital in the UK and US in order to understand the potential gains and pitfalls in using a clinical registry such as NSQIP to evaluate care in two different countries.
Methods: NSQIP data for 100 consecutive patients diagnosed with surgical site infection from one US hospital and 83 from one UK hospital between 2011-2013 were retrieved. Additional clinical information from hospital records was collected retrospectively, to include pre-operative, perioperative and post-operative process measures for SSI prevention, as well as differences in post-discharge diagnosis and healthcare utilization.
Results: 98 and 80 correct diagnoses of SSI in the US and UK respectively were reviewed. Significant pre-operative preventative practice differences were observed as well as post-discharge management.
Conclusion: ACS-NSQIP identified St Mary's hospital in the UK as an outlier for surgical site infection. The reasons for this are multifactorial, including different peri-operative and intra-operative technical processes, which may reflect genuine differences in the quality of care provided, or the quality of the underlying data. The reliability of post-discharge diagnoses is questionable, with more SSIs diagnosed and managed by primary care physicians in the UK and more patients in the US with immediate access to the lead surgical team.
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