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For: Butler MW, Zarosinski S, Rockstroh D. Improvement of surgical wound classification following a targeted training program at a children's hospital. J Pediatr Surg 2018;53:2378-2382. [PMID: 30268490 DOI: 10.1016/j.jpedsurg.2018.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/25/2018] [Indexed: 11/28/2022]

For:	Butler MW, Zarosinski S, Rockstroh D. Improvement of surgical wound classification following a targeted training program at a children's hospital. J Pediatr Surg 2018;53:2378-2382. [PMID: 30268490 DOI: 10.1016/j.jpedsurg.2018.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/25/2018] [Indexed: 11/28/2022]

Number

Cited by Other Article(s)

Meoli A, Ciavola L, Rahman S, Masetti M, Toschetti T, Morini R, Dal Canto G, Auriti C, Caminiti C, Castagnola E, Conti G, Donà D, Galli L, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Simonini A, Venturini E, Caramelli F, Gargiulo GD, Sesenna E, Sgarzani R, Vicini C, Zucchelli M, Mosca F, Staiano A, Principi N, Esposito S. Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention. Antibiotics (Basel) 2022;11:antibiotics11070863. [PMID: 35884117 PMCID: PMC9311619 DOI: 10.3390/antibiotics11070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open

Affiliation(s)

Aniello Meoli Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Lorenzo Ciavola Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Sofia Rahman Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Marco Masetti Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Tommaso Toschetti Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Riccardo Morini Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Giulia Dal Canto Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
Cinzia Auriti Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
Caterina Caminiti Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
Elio Castagnola Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
Giorgio Conti Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
Daniele Donà Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
Luisa Galli Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
Stefania La Grutta Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
Laura Lancella Paediatric Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
Mario Lima Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
Andrea Lo Vecchio Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
Gloria Pelizzo Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
Nicola Petrosillo Infection Prevention and Control—Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, 00128 Rome, Italy;
Alessandro Simonini Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
Elisabetta Venturini Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
Fabio Caramelli Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
Gaetano Domenico Gargiulo Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
Enrico Sesenna Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
Rossella Sgarzani Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
Claudio Vicini Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
Mino Zucchelli Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy;
Fabio Mosca Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
Annamaria Staiano Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
Nicola Principi Università degli Studi di Milano, 20122 Milan, Italy;
Susanna Esposito Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.) Correspondence: ; Tel.: +39-0521-903524
on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group

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Singh S, Podila S, Pyon G, Blewett J, Jefferson J, McKee R. An analysis of 3,954 cases to determine surgical wound classification accuracy: Does your institution need a monday morning quarterback? Am J Surg 2020;220:1115-1118. [PMID: 32359689 DOI: 10.1016/j.amjsurg.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 04/04/2020] [Accepted: 04/14/2020] [Indexed: 11/20/2022]

Abstract

INTRODUCTION

Surgical site infections reporting has financial implications for institutions under Centers for Medicare and Medicaid Services (CMS) Pay-for-Performance programs. Surgical Wound Classification (SWC) is an important factor in performing risk adjustment and affects the accuracy of the Standardized Infection Ratio (SIR). This in turn leads to more accurate inter-hospital ratings and reimbursement. This study aims to measure (1) services and procedures associated with the highest rates of misclassification and (2) whether temporal factors influenced misclassification.

METHODS

Accuracy of SWC was assessed by comparing the wound classification documented by the Operating Room (OR) nurse at the time of the operation to the actual SWC determined from in-depth chart review using Centers for Disease Control and Prevention (CDC) wound classification algorithm by a trained reviewer. Cases were reviewed once operative reports were available.

RESULTS

Review of 3954 cases yielded an overall discordance rate of 22.15% (N = 876), with most cases being under-classified. Services with the highest rates of discordance include cardiothoracic (38.46%) and general surgery (37.86%), followed by general oncology (29.46%), OB-GYN (28.93%), urology (27.27%), and plastic surgery (27.14%). Procedures with the highest discordance rates are laparoscopic appendectomy (66.67%), cholecystectomy (52.90%), exploratory laparotomy (49.21%), and split-thickness skin graft (36.84%). Discordance rates were significantly higher (p = 0.0001) during weekends compared to weekdays, while operations starting after-hours during the week did not show a significant difference from daytime hours.

CONCLUSION

At a level 1 trauma academic medical center, certain procedures were found to be misclassified in regards to SWC more often than other types of cases. The timing of the case, such that they occurred on the weekends also contributed to higher discordance rates between original and corrected wound classifications. Recognizing cases, services, and temporal factors frequently associated with misclassification of wound class can help allocate limited resources to maximize improvement of this important metric.

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