AMBU-KISS: Quality control in ambulatory surgery

doi:10.1016/j.ajic.2004.09.004

American Journal of Infection Control

Volume 33, Issue 1, February 2005, Pages 11-14

https://doi.org/10.1016/j.ajic.2004.09.004 Get rights and content

Background

Cost-containment measures have led to a constant increase in the number of patients cared for as outpatients. Several studies have demonstrated that surgical site infections result in considerable morbidity and excess health care costs from extended duration of hospitalization and antibiotic use.

Objective

AMBU-KISS is a protocol designed to create a reference database on surgical site infections for institutions involved in ambulatory surgery.

Methods

This study was carried out using a physician questionnaire. We compared surgical site infection rates for 3 indicator procedures in the ambulatory setting to those observed in the inpatient setting. The 3 indicator procedures chosen for the protocol were arthroscopic knee surgery and inguinal hernia and vein-stripping procedures.

Results

The arithmetic mean values of surgical site infection rates in arthroscopic surgery of the knee are 0.09% in the ambulatory setting and 0.11% in the hospital setting. For inguinal hernias, the respective rates are 0.65% and 0.78%. These differences, however, did not reach statistical significance (arthroscopic surgery, P = .8323 and inguinal herniotomies, P = .4895). A marked difference was observed for vein-stripping procedures, with surgical site infection rates of 0.38% in the ambulatory setting and 0.64% in the hospital setting. However, this difference was also not statistically significant, P = .1556.

Conclusion

The AMBU-KISS protocol appears to be suitable for assessing and defining the magnitude of surgical site infections in ambulatory surgery. The preliminary results of our study show no significant differences for the 3 indicator procedures.

Section snippets

Methods

The AMBU-KISS module was designed and implemented in October 2002. At present, the protocol includes 3 indicator surgical procedures, ie, arthroscopic knee surgery, inguinal herniotomy (with and without implants), and vein stripping. These were chosen because a preliminary assessment of the situation showed that, in the majority of institutions, these were the procedures carried out most frequently on an ambulatory basis. Furthermore, a reference database for these indicator procedures had

Results

After a relatively short study period of 9 months (October 2002 to June 2003), 16,045 surgical procedures were available for analysis. Stratification showed that 52 institutions submitted data on 7931 arthroscopic knee surgery procedures, 53 institutions on 3094 inguinal herniotomy, and 50 institutions on 5020 vein-stripping procedures. An infection rate of 0.09% (7/7931) was observed in the subgroup arthroscopic knee surgery. Corresponding values for inguinal herniotomy and vein-stripping

Discussion

In recent years, health care cost containment has led, among other things, to the introduction of ambulatory surgery as part of patient management. In various medical fields, a growing number of patients are now cared for on an outpatient basis. Thus, it appears logical that the quality standards of these institutions should be scrutinized and, if necessary, improved. Quality standards have been established for the hospital setting, and individual hospitals can use reference databases to assess

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A systematic review of surgical site infections following day surgery: a frequentist and a Bayesian meta-analysis of prevalence
2019, Journal of Hospital Infection
Citation Excerpt :
The result was similar using the Sidik–Jonkman method (1.35%, 95% CI 1.1–1.6). The influence of large studies (>10,000 individuals) was small, as shown when these studies were removed [4,22,42,43,60,62,63,70,71,74,76,79,107]. When the three largest studies [22,62], representing 73% of the overall population, were removed, the global prevalence was 1.8% (95% CI 1.36–2.3).
Since 1990, several studies have focused on safety and patient satisfaction in connection with day surgery. However, to date, no meta-analysis has investigated the overall prevalence of surgical site infections (SSI).
To estimate the overall prevalence of SSI following day surgery, regardless of the type of surgery.
A systematic review and a meta-analysis of the prevalence of SSI following day surgery, regardless of the type of surgery, was conducted, seeking all studies before June 2016. A pooled random effects model using the DerSimonian and Laird approach was used to estimate overall prevalence. A double arcsine transformation was used to stabilize the variance of proportions. After performing a sensitivity analysis to validate the robustness of the method, univariate and multi-variate meta-regressions were used to test the effect of date of publication, country of study, study population, type of specialty, contamination class, time of postoperative patient visit after day surgery, and duration of hospital care.
Ninety articles, both observational and randomized, were analysed. The estimated overall prevalence of SSI among patients who underwent day surgery was 1.36% (95% confidence interval 1.1–1.6), with a Bayesian probability between 1 and 2% of 96.5%. The date of publication was associated with the prevalence of SSI (coefficient −0.001, P = 0.04), and the specialty (digestive vs non-digestive surgery) tended to be associated with the prevalence of SSI (coefficient 0.03, P = 0.064).
The meta-analysis showed a low prevalence of SSI following day surgery, regardless of the surgical procedure.
Epidemiology of the medico-legal risk associated with the practice of ambulatory surgery in France: A study based on insurance data
2014, Annales Francaises d'Anesthesie et de Reanimation
Le risque médico-légal spécifiquement lié à la pratique de la chirurgie ambulatoire (CAMB) est encore mal précisé. SHAM, premier assureur en responsabilité civile médicale en France, est une source pertinente d’informations par le biais des dommages ayant conduit à une déclaration de sinistre.
Le but de l’étude était de décrire la sinistralité en CAMB comparé à la chirurgie non ambulatoire (CNA).
Nous avons réalisé une étude rétrospective des dossiers de sinistres déclarés auprès de SHAM et clôturés entre 2007 et 2011 pour comparer l’épidémiologie de la sinistralité en CAMB versus CNA.
L’ensemble des dossiers a été colligé dans la base de données SHAM, puis analysé.
Sur la période, la CAMB a généré 467 déclarations de sinistres parmi les 29 565 sinistres enregistrés soit 1,6 % du total des sinistres déclarés ; 2151 sinistres sur 29 098 en CNA ont conduit à une condamnation par un tribunal soit 7,4 % versus 33/467 en CAMB soit 7 %. Les condamnations pour la CAMB représentent donc 1,5 % du total (33/2184) pour 1,7 M€ (versus 400,3 M€ pour CNA) soit un coût moyen de 50 500 € (versus 186 000 € en CNA). Les spécialités concernées sont principalement la chirurgie ophtalmologique, digestive et orthopédique. Les principales causes sont une faute médicale (n = 16) ou une infection nosocomiale (n = 13).
En CAMB, la sinistralité est proportionnellement moins fréquente avec des indemnisations trois fois inférieures et correspond aux chirurgies les plus pratiquées. Sa connaissance permettra d’aider à renforcer la démarche qualité en CAMB.
The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery.
The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery.
We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery.
We searched the files in the SHAM database, and then analyzed them.
On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n = 16) and nosocomial infections (n = 13).
The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery.
Surgical-site infections following varicose vein surgery according to a continuous series of 408 interventions in a teaching hospital
2011, Pathologie Biologie
Notre objectif était de déterminer l’incidence des infections du site opératoire (ISO) consécutives à des interventions sur varices dans le service de chirurgie vasculaire d’un centre hospitalier universitaire.
Une surveillance prospective des ISO a été mise en place pendant un an, avec un suivi postopératoire des patients de 30 jours. Le diagnostic d’ISO a été réalisé suivant les définitions des Centers for Disease Control (CDC, États-Unis). La saisie et l’analyse des données ont été réalisées à l’aide du logiciel Epi-Info des CDC.
Les trois-quarts des 408 interventions incluses étaient caractérisées par un score de NNISS égal à 0. Une dépilation a été effectuée pour tous les patients, avec des modalités très variables et souvent non conformes (rasage mécanique dans 44,6 % des cas) aux recommandations nationales. L’incidence des ISO était de 1,2 % (intervalle de confiance à 95 % = [0,2–2,2]). Toutes les infections ont été diagnostiquées après retour au domicile. Quatre patients infectés sur cinq présentaient des problèmes de surpoids ou d’obésité et deux d’entre eux étaient diabétiques. L’âge moyen des patients était plus élevé chez les patients infectés (70,4 ans versus 52,0 ; p < 0,01). Les cinq ISO ont eu des conséquences (réhospitalisation et/ou reprise chirurgicale et/ou antibiothérapie).
D’après ces résultats, les ISO consécutives à des interventions sur varices sont rares et concernent principalement des patients à haut risque. Dans un but de prévention, il semble cependant nécessaire d’homogénéiser les pratiques de dépilation dans ce service.
To determine the incidence of surgical-site infections (SSI) following varicose vein surgery in the vascular surgery ward of a French teaching hospital.
A prospective surveillance of SSI was conducted during one year, with a 30-day postoperative follow-up. SSI cases were identified by using the definitions of the Centers for Disease Control (CDC, USA). Data acquisition and analysis were performed with the Epi-Info 6.04 software (CDC).
Three quarters of the 408 included interventions were characterized by a NNIS score equal to 0. All patients underwent a hair removing practice before intervention. Hair removing methods were very heterogeneous and often not in accordance with national recommendations (e.g. mechanic shaving for 44.6% of patients). The incidence of SSI was 1.2% (95% confidence interval = [0.2–2.2]). All infections were identified after hospital discharge. Four infected patients out of five presented obesity or excess weight, and two patients had diabetes mellitus. The mean age of infected patients was significantly higher than non-infected ones (70.4 years versus 52.0; p < 0.01). All SSI had consequences like rehospitalization, reintervention, or antimicrobial therapy.
According to our results, SSI following varicose vein surgery are scarce and mainly concerned high-risk patients. However, in an aim of prevention, it seems necessary to homogenize hair removing methods in this ward.
Revisiting the ASPAN Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia
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2009, Krankenhaushygiene und Infektionsverhutung
Ten years of KISS: The most important requirements for success
2008, Journal of Hospital Infection
Ten years ago, in January 1997, data collection for the German national nosocomial infection surveillance system was established, which is known by the acronym KISS (Krankenhaus-Infektions-Surveillance-System). Meanwhile KISS was able to demonstrate a beneficial effect from ongoing surveillance activities and appropriate feedback to the users in combination with reference data for ventilator associated pneumonia, primary bloodstream infections and surgical site infections. Significant reductions of infection rates between 20-30% over 3 years periods in the components for intensive care units, operative departments and neonatal intensive care units were demonstrated.
Due to our experience the following requirements have to be fulfilled to keep a surveillance system successful over longer periods: close contact between the participating institutions, consideration of new developments, timely regular data feedback and constant reevaluation of the way of data presentation, data validity and demonstration of its contribution to the reduction of healthcare associated infections (HAI). The article describes in more detail how KISS tries to fulfill these requirements.

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Major ArticleAMBU-KISS: Quality control in ambulatory surgery

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Am J Infect Control

J Clin Epidemiol

Am J Infect Control

J Hosp Infect

J Hosp Infect

The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs

Infect Control Hosp Epidemiol

Selected aspects of socioeconomic impact of nosocomial infections: morbidity, mortality, cost and prevention

Infect Control Hosp Epidemiol

The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost

Infect Control Hosp Epidemiol

Risk factors for spinal surgical site infections in a community hospital: a case-control study

Infect Control Hosp Epidemiol

The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals

Am J Epidemiol

Major Article
AMBU-KISS: Quality control in ambulatory surgery