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Is It Valid to Compare Surgical Site Infections Rates Between Countries? Insights From a Study of English and Norwegian Surveillance Systems

Published online by Cambridge University Press:  08 November 2016

Hinta Meijerink ,
Theresa Lamagni ,
Hanne Merete Eriksen ,
Suzanne Elgohari ,
Pauline Harrington  and
Oliver Kacelnik
Hinta Meijerink
Affiliation:
Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute for Public Health, Oslo, Norway European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
Theresa Lamagni
Affiliation:
National Infection Service, Public Health England, London, United Kingdom
Hanne Merete Eriksen
Affiliation:
Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute for Public Health, Oslo, Norway
Suzanne Elgohari
Affiliation:
National Infection Service, Public Health England, London, United Kingdom
Pauline Harrington
Affiliation:
National Infection Service, Public Health England, London, United Kingdom
Oliver Kacelnik*
Affiliation:
Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute for Public Health, Oslo, Norway
*
Address correspondence to Oliver Kacelnik, Norwegian Institute of Public Health, Domain of Infection Control and Environmental Health. P.O. Box 4404, Nydalen, NO–0403 Oslo, Norway (Oliver.Kacelnik@fhi.no).
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Abstract

OBJECTIVE

To assess whether differences in surveillance methods or underlying populations significantly influence internationally reported national SSI rates by comparing surveillance data from 2 countries.

DESIGN

Retrospective cohort.

SETTING

England and Norway.

METHODS

We assessed the population under surveillance and surveillance methodology to compare SSI rates in 2 countries (September 2012–January 2015) for 4 surgical categories: coronary artery bypass graft (CABG), colon surgery, cholecystectomy, and hip prosthesis (HPRO). We compared the inpatient SSI incidence using logistic regression, adjusting for the following known risk factors: sex, age, ASA score, wound class, postoperative hospital days, and operation duration. Subsequently, we restricted further analyses to the procedures reported by both countries.

RESULTS

There were important differences in case definitions for superficial infection, so we restricted our analyses to deep incisional and organ-space SSIs. For CABG, the crude odds ratio (OR) for England compared to Norway was 2.4 (95% CI, 1.4–4.4), whereas adjusted OR (aOR) lost significance (aOR, 1.1; 95% CI, 0.57–2.0). For colon surgery the decreased odds (OR, 0.68; 95% CI, 0.56–0.81) remained significant after adjustment (aOR, 0.42; 95% CI, 0.34–0.51). We found no associations for cholecystectomy. For HPRO, the crude OR suggested no significant difference (OR, 1.2; 95% CI, 0.72–2.1), whereas the aOR was significantly lower in England (aOR, 0.45; 95% CI, 0.25–0.81). Including only the subset of procedures reported by both countries yielded comparable results.

CONCLUSION

Differences in case definitions and population under surveillance in the English and Norwegian SSI surveillance systems affected SSI estimates, making the comparison of crude rates unreliable. Standardized definitions and adjustment for established risk factors are essential for European comparisons to guide related public health actions.

Infect Control Hosp Epidemiol 2017;38:162–171

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 162 - 171
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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