The Dutch PREZIES network: national surveillance systems-more than just data collection
Abstract number: 1133_111
Surgical Site Infections (SSI) are important complications of surgery. Although many advances have been made in asepsis, antisepsis and surgical technique over the last century, infections are still relatively frequent complications.The pathogenesis of SSI is complex and not completely understood. Therefore, prevention can only be partly achieved by control of the process and outcome measurement remains essential for optimal performance. Repeatedly it has been shown that measuring of SSI-rates with active reporting of these rates to the surgeons results in a reduction of the SSI-rate. Although this is generally accepted there is no consensus how to do this. There are many aspects that should be taken care of, to produce reliable and reproducible SSI-rates. Things get even more critical when these rates are used for comparisons. The following aspects are of major importance: Definitions, case-finding methods and control for confounding (risk factors should be taken into account).In the last decade several large, multicentre, surveillance projects have been performed and have shown that significant variations in the SSI-rates between different hospitals exist. However, these variations were for an important part caused by differences in the case-finding methods used or by differences in the population of patients operated on. Therefore, they do not necessarily reflect true differences in the performance of the participating centres. Also, it has been shown that centres that participate in such projects for several years achieve a significant reduction of the SSI-rates. It are true quality improvement projects. The conclusion is that measuring SSI-rates in a standardised way with reporting of the rates to those that can improve the outcome, improves the quality of care. Now those rates have been gathered, there is a demand from the public to know the hospital specific rates. One of the main reasons for this must be that patients should be able to make a more justified decision were they want to be operated. The question is if this is a justified assumption? There are several arguments against publication of SSI-rates: 1) It is likely that the SSI-rates will be less reliable (too low) when they are published in a way that the centre or even surgeon involved can be identified. 2) The risk factors involved are not known completely and therefore the observed differences do not necessarily reflect true differences in performance. In conclusion, although the public demand seems reasonable at a first glance it is not the way to go at this time. The SSI-rates cannot be used to make a reliable decision were to be operated most safely (apart from other aspects of the surgical procedure that are of importance). Moreover, if it is enforced to publish SSI-rates this will likely terminate one of the most important methods to improve quality in surgery currently available.
|Session name:||XXIst ISTH Congress|
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