Percentage of adult colectomy cases that had a surgical site infection within 30 days after surgery as defined and reported by the Michigan Surgical Quality Collaborative (MSQC).

Surgical site infections (SSIs) occur at the site of surgical incision and can lead to serious complications resulting in prolonged hospital stays, increased healthcare costs and mortality. Hyperglycemia, hypothermia, and inadequate antibiotic prophylaxis can all lead to increased SSIs and are modifiable factors in intraoperative care.  Anesthesia providers play an integral role in reducing the risk of patients developing an SSI.^1-6 

Out of room time on day of surgery through 30 days after surgery

• Cases that match with an MSQC registry case as determined by MSQC Case Matching 
• Case was a colectomy procedure as determined by MSQC Procedure Group (value code: 3)

Cases that do not match with an MSQC case as determined by MSQC Case Matching

Case did not have a surgical site infection within 30 days after surgery as defined by MSQC Postoperative Outcomes (value codes: 1, 2, 3)

 MPOG has partnered with the Michigan Surgical Quality Collaborative (MSQC) to merge MPOG and MSQC data in order to report SSI outcomes to Michigan hospitals participating with both collaboratives. MSQC is a Collaborative Quality Initiative funded by Blue Cross Blue Shield of Michigan (BCBSM) and committed to enhancing surgical quality and clinical outcomes for patients undergoing general surgery. MSQC maintains a data repository of perioperative data, abstracted and validated by nurses throughout Michigan. A stratified sampling methodology is used to capture a representative portion of surgical cases. This involves a repeating and rotating 8-day cycle over a 12-month period and is limited to a subset of surgical CPT codes. MSQC classifies SSIs in three categories: Superficial Incisional, Deep Incisional, and Organ/Space. MSQC cases were matched to the corresponding MPOG case using the matching algorithm specified in the MSQC Case Matching phenotype. Only MPOG cases that were successfully matched to an MSQC case were included in the denominator for this measure. Both the rate of SSI infection as well as the raw count are reported in the MPOG QI Reporting Tool. 

• Surgical Site Infections (SSIs) are assigned to the anatomic site of the Principal Operative Procedure.
• Principal Operative Procedure is defined by MSQC as the ‘index’ procedure that meets the inclusion criteria for colectomy based on CPT codes. Cases must be performed in an operating room or ‘hybrid’ room to be considered as the Principal Operative Procedure. 
• If multiple procedures are performed during a case, and more than one CPT code meets the MSQC inclusion criteria for a case, the following priority algorithm is applied to determine the Principal Operative Procedure (highest priority listed first):
  • The CPT associated with the primary disease/diagnosis that led to surgery (colectomy if primary diagnosis was colon cancer)
  • By the organ that provided the more ‘acute’ indication for surgery as described in the operative report
  • May be the most complex procedure performed by the operating team during the visit to the operating room
  • The procedure is listed on the Appendix A-B: MSQC-included CPT codes and CPT enabled variables list
  • The surgeon who scheduled the procedure or the surgeon treating the patient for the main preoperative diagnosis
• For procedures with multiple incision sites and/or multiple SSIs found, only the deepest tissue level involved is reported once in the 30 days after surgery. For example, if one laparoscopic incision meets criteria for a superficial incisional SSI and another meets criteria for a deep incisional SSI, only the deep incisional SSI will be reported to MSQC.
• Other details resulted in the case list include:
  • MSQC Procedure Type 
  • Type of Surgical Site Infection as determined by MSQC Postoperative Outcomes 
  • SSI Occurrence Timeframe:
    • 0-7 Days Postop = 1 (early complication)
    • 8-30 Day Postop = 2 (late complication)
• More details regarding MSQC SSI definitions are described in the Appendix (copied directly from the 2025 MSQC Program Manual)

Appendix: 

MSQC Definitions for Surgical Site Infection

Superficial Incisional SSI 

Superficial Incisional SSI must meet the following 3 criteria:

1. Date of occurrence within 30 days following the operation date (POD 0 = operation date)
2. Infection involves only skin and subcutaneous tissue of the incision
3. Patient has at least one of the following:
   1. Purulent drainage from superficial incision
   2. Organism identified from culture of superficial incision or subcutaneous tissue
   3. superficial incision that is deliberately opened and culture is not performed, and patient has at least one of the following signs or symptoms:
      • localized pain or tenderness
      • localized swelling
      • erythema
      • heat
   4. Diagnosis of superficial incisional SSI by a physician or physician designee

The following do not qualify as criteria to meet the definition of superficial incisional SSI:

• Diagnosis/treatment of cellulitis by itself does not meet criterion “d” for superficial incisional SSI. Note: An incision that is draining purulence or has a positive culture is not considered cellulitis, but rather criteria for an SSI.
• A stitch abscess alone (minimal inflammation and discharge confined to the points of suture penetration).
• A localized stab wound or pin site infection. The term “stab wound” refers to an incision made at another site, generally to accommodate a drain. The term “incision” refers to the incision made for the primary surgical procedure. Note: A laparoscopic trocar site for an operative procedure is considered a surgical incision and not a stab wound. If a surgeon uses a laparoscopic trocar site to place a drain at the end of a procedure this is considered a surgical incision.

Deep Incisional SSI 

Deep Incisional SSI must meet the following 3 criteria:

1. Date of occurrence occurs within 30 days following the operation date (POD 0 = operation date)
2. Infection involves deep soft tissues of the incision (e.g., fascial and muscle layers)
3. Patient has at least one of the following:
   1. purulent drainage from the deep incision
   2. a deep incision that spontaneously dehisces, or is deliberately opened [excluding planned /staged return to OR] or aspirated by a physician or physician designee
      • and organism identified from culture of deep incision or culture is not performed. Note: If there is a culture of the deep incision and it is negative, you cannot use criteria 3b to assign deep incisional SSI, but you can use 3a or 3c.
      • and patient has at least one of the following signs or symptoms:
        • fever (>38°C±)
        • localized pain or tenderness ± As documented in the medical record (i.e., no conversion of temperature based on route of collection).
   3. an abscess or other evidence of infection involving the deep incision that is detected on gross anatomical or histopathologic exam, or imaging test

Organ/Space SSI

Organ/Space SSI must meet the following 4 criteria:

1. Date of occurrence occurs within 30 days following the operation date (POD 0 = operation date)
2. Infection involves any part of the body, deeper than the fascial/muscle layers, that is opened or manipulated during the [principal] operative procedure 
3. Patient has at least one of the following: 
   1. Purulent drainage from a drain that is placed into the organ/space (e.g., closed suction drainage system, open drain, Ttube drain, CT guided drainage)
   2. Organisms identified from a culture of fluid or tissue in the organ/space 
   3. An abscess or other evidence of infection involving the organ/space that is detected on gross anatomical or histopathologic exam, or imaging test suggestive of infection 
4. Meets at least one criterion for a specific organ/space infection site listed in Table 1. 

Note: Because an Organ/Space SSI involves any part of the body (excluding the skin incision, subcutaneous tissue, fascia, and muscle layers) that is opened or manipulated during the operative procedure, the criteria for infection at the specific body site must be met in addition to the ‘general’ organ/space SSI criteria above. For example, an appendectomy with subsequent RLQ abscess would be reported as an organ/space SSI when both organ/space SSI and intra abdominal criteria are met. Table 1 lists the ‘specific sites’ for which criteria must be met in order to assign organ/space SSI.

Table 1: Site-Specific Criteria Sets for Organ/Space SSI with example procedures

Not applicable

Departmental only measure - not available for provider feedback emails

1. Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D: Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377:228–41   
2. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011-2012 2013 at <https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-0>   
3. WHO Guidelines Approved by the Guidelines Review Committee. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization (c) World Health Organization 2018.; 2018.
4. Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA surgery. 2017;152(8):784-791.
5. Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B, Musa I: Global incidence of surgical site infection among patients: Systematic review and meta-analysis. Inquiry 2023; 60:469580231162549   
6. CDC/National Healthcare Safety Network (NHSN). (January 2025). Patient Safety Component Manual. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf