Improved Risk Adjustment for Comparison of Surgical Site Infection Rates

2006 ◽  
Vol 27 (12) ◽  
pp. 1330-1339 ◽  
Author(s):  
Eveline L. P. E. Geubbels ◽  
Diederick E. Grobbee ◽  
Christina M. J. E. Vandenbroucke-Grauls ◽  
Jan C. Wille ◽  
Annette S. de Boer
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Risk Adjustment ◽  
Predictive Power ◽  
Hip Prosthesis ◽  
Risk Index ◽  
Site Infection ◽  
Total Hip Prosthesis ◽  
Infection Surveillance ◽  
Femorotibial Bypass

Objective.To develop prognostic models for improved risk adjustment in surgical site infection surveillance for 5 surgical procedures and to compare these models with the National Nosocomial Infection Surveillance system (NNIS) risk index.Design.In a multicenter cohort study, prospective assessment of surgical site infection and risk factors was performed from 1996 to 2000. In addition, risk factors abstracted from patient files, available in a national medical register, were used. The c-index was used to measure the ability of procedure-specific logistic regression models to predict surgical site infection and to compare these models with models based on the NNIS risk index. A c-index of 0.5 indicates no predictive power, and 1.0 indicates perfect predictive power.Setting.Sixty-two acute care hospitals in the Dutch national surveillance network for nosocomial infections.Participants.Patients who underwent 1 of 5 procedures for which the predictive ability of the NNIS risk index was moderate: reconstruction of the aorta (n= 875), femoropopliteal or femorotibial bypass (n= 641), colectomy (n= 1,142), primarytotal hip prosthesis (n= 13,770), and cesarean section (n= 2,962).Results.The predictive power of the new model versus the NNIS index was 0.75 versus 0.62 for reconstruction of the aorta (P< .01), 0.78 versus 0.58 for femoropopliteal or femorotibial bypass (P< .001), 0.69 versus 0.62 for colectomy (P< .001), 0.64 versus 0.56 for primary total hip prosthesis arthroplasty (P< .001), and 0.70 versus 0.54 for cesarean section (P< .001).Conclusion.Data available from hospital information systems can be used to develop models that are better at predicting the risk of surgical site infection than the NNIS risk index. Additional data collection may be indicated for certain procedures–for example, total hip prosthesis arthroplasty.

Finding a Method for Optimizing Risk Adjustment When Comparing Surgical-Site Infection Rates

2004 ◽  
Vol 25 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Christian Brandt ◽  
Sonja Hansen ◽  
Dorit Sohr ◽  
Franz Daschner ◽  
Henning Rüden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Regression Models ◽  
Predictive Power ◽  
Risk Index ◽  
Significant Risk ◽  
Site Infection ◽  
Logistic Regression Models ◽  
System Risk

AbstractObjective:To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index.Design and Setting:The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations).Methods:For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models.Results:For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index.Conclusion:Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.

scholarly journals Surgical site infection in patients submitted to orthopedic surgery: the NNIS risk index and risk prediction

2011 ◽  
Vol 19 (2) ◽  
pp. 269-276 ◽  
Author(s):  
Flávia Falci Ercole ◽  
Tânia Couto Machado Chianca ◽  
Denise Duarte ◽  
Carlos Ernesto Ferreira Starling ◽  
Mariângela Carneiro
Keyword(s):  
Surgical Site Infection ◽  
Prediction Models ◽  
Risk Index ◽  
Surgical Patients ◽  
Site Infection ◽  
Multivariate Logistic Regression ◽  
Historical Cohort ◽  
Infection Surveillance ◽  
Proposed Model ◽  
Alternative Index

The applicability of the risk index for surgical site infection of the National Nosocomial Infection Surveillance (NNIS) has been evaluated for its performance in different surgeries. In some procedures, it is necessary to include other variables to predict. Objective: to evaluate the applicability of the NNIS index for prediction of surgical site infection in orthopedic surgeries and to propose an alternative index. The study involved a historical cohort of 8236 patients who had been submitted to orthopaedic surgery. Statistical analysis was performed using multivariate logistic regression to fit the model. The incidence of infection was 1.41%. Prediction models were evaluated and compared to the NNIS index. The proposed model was not considered a good predictor of infection, despite moderately stratified orthopedic surgical patients in at least three of the four scores. The alternative model scored higher than the NNIS models in the prediction of infection.

scholarly journals Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xufei Zhang ◽  
Zhiwei Wang ◽  
Jun Chen ◽  
Peige Wang ◽  
Suming Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Large Scale ◽  
Risk Index ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Cross Sectional ◽  
Medical Expenses ◽  
Related Risk

Abstract Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

scholarly journals Surgical site infection surveillance in orthopedic patients in the Military Medical Academy, Belgrade

2015 ◽  
Vol 72 (6) ◽  
pp. 499-504 ◽  
Author(s):  
Srdjan Starcevic ◽  
Stasa Munitlak ◽  
Biljana Mijovic ◽  
Dragan Mikic ◽  
Vesna Suljagic
Keyword(s):  
Risk Factors ◽  
Incidence Rate ◽  
Risk Index ◽  
Site Infection ◽  
Reduction Strategy ◽  
Military Medical Academy ◽  
Infection Surveillance ◽  
Medical Academy ◽  
Orthopedic Patients ◽  
The Military

Background/Aim. Active surveillance is an important component of surgical site infection (SSI) reduction strategy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA), Belgrade. Methods. A 4-year prospective cohort study was performed to identify the incidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding patients characteristics, health care and microorganisms isolated in SSI. The National Nosocomial Infection Surveillance (NNIS) risk index was subsequently calculated for each patient. The Centers for Disease Control and Prevention criteria were used for the diagnosis of SSI. Results. Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077) patients with risk 0 - the incidence rate of 1.4%; 38.9% (1,506) patients with risk 1 - the incidence rate of 3.1%; 7.3% (281) patients with risk 2 - the incidence rate of 11.7%; 0.1% (3) patients with risk 3 - without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaminated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. Conclusion. The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6%) during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.

Prevalence and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China

2020 ◽  
Author(s):  
Yu Zhang ◽  
Hui-Quan Gan ◽  
Jing-Fang Zhou ◽  
Ya-Jie Gong ◽  
Liu-Yi Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Prevalence Rate ◽  
Demographic Data ◽  
Risk Index ◽  
Klebsiella Pneumonia ◽  
Site Infection ◽  
Extended Spectrum Beta Lactamase

Abstract Background: Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China . This study aims to investigate the prevalence, risk factors and microbiology of SSI after CRS. Methods: A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models. Results: Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The prevalence rate of SSI decreased from 5.9 infections per 100 procedures in 2014 to 3.1 infections per 100 procedures in 2017 (prevalence rate ratio [PRR], 0.52; 95% CI, 0.28–0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03–5.02) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88–6.06) were significantly associated with increasing risk of SSI after CRS. Conclusion: A statistically significant but modest decrease in the prevalence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert despite of the small number of isolates identified in our survey.

scholarly journals A prospective study of surgical site infection of orthopedic implant surgeries

2017 ◽  
Vol 4 (1) ◽  
pp. 1 ◽  
Author(s):  
Muhammad Thahir ◽  
Suresh Gandhi ◽  
Kalaivanan Kanniyan ◽  
Ravi Kumar
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Risk Index ◽  
Univariate Analysis ◽  
Cost Of Care ◽  
Orthopaedic Implant ◽  
Site Infection ◽  
Duration Of Surgery

<p class="abstract"><strong>Background:</strong> Surgical-site infection accounts for approximately 10% of all hospital-acquired infections, which are estimated to double the cost of care and result in an additional mean of 6.5 days of hospital stay. We did prospective study of surgical site infection of orthopaedic implant surgeries.</p><p class="abstract"><strong>Methods:</strong> The aim of the study is to assess the clinical and microbiological outcome of 125 patients who had open reduction and internal fixation with implants and prosthesis at Southern Railway Hospital from January 2006 to January 2007, and its strength of association with major risk factors using univariate analysis. In our study, Patients were allocated in to three groups as NINS risk index group 0, 1 and 2 with risk factors as duration of surgery &gt;2 hours and ASA class ≥3. Post-operative wound infection was diagnosed based on the criteria of Center of Disease Control and assessed for the period of 6 weeks using National Nosocomial Infections Surveillance Risk Index.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 87 male and 38 females in the study. From 125 Patients, 13 patients had post-operative superficial surgical site infection and presented within 21 days of operation. The infection rate was 10.4%. Two Patients developed deep infection after 6 weeks of study. All the cases with superficial infection were followed at regular intervals, 11 cases resolved with regular dressing and antibiotics but 2 cases continued to discharge sinus up to 3 months.</p><p><strong>Conclusions:</strong> The study showed that the risk of infection rate increased significantly with ASA score, duration of surgery, obesity and NINS risk index. There was no significant association of infection rate with age, diabetes and smoking. </p>

Risk Factors for Surgical Site Infection in Children

2006 ◽  
Vol 27 (7) ◽  
pp. 709-715 ◽  
Author(s):  
Juan Francisco Casanova ◽  
Rafael Herruzo ◽  
Jesús Díez
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Pediatric Patients ◽  
Risk Index ◽  
Venous Catheter ◽  
University Hospital ◽  
Site Infection ◽  
Convenience Sample ◽  
Peripheral Venous Catheter ◽  
Duration Of Surgery

Objectives.To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients.Design.Cohort study during more than 4 years.Setting.La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants.Patients.Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days.Results.A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver–operating characteristic curve were higher than that of the SENIC index.Conclusions.The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.

The effect of body mass index on the risk of surgical site infection

2019 ◽  
Vol 40 (9) ◽  
pp. 991-996 ◽  
Author(s):  
Anouk P. Meijs ◽  
Mayke B.G. Koek ◽  
Margreet C. Vos ◽  
Suzanne E. Geerlings ◽  
H. Charles Vogely ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Surgical Site Infection ◽  
Body Mass ◽  
Surgical Procedures ◽  
Hip Prosthesis ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Site Infection ◽  
Total Hip Prosthesis

AbstractObjective:Obesity is considered a risk factor for surgical site infection (SSI). We quantified impact of body mass index (BMI) on the risk of SSI for a variety of surgical procedures.Methods:We included 2012–2017 data from the Dutch national surveillance network PREZIES on a selection of frequently performed surgical procedures across different specialties. Patients were stratified into 5 categories: underweight (BMI, <18.5 kg/m2), normal weight (BMI, 18.5–25), overweight (BMI, 25–30), obese (BMI, 30–40) and morbidly obese (BMI, ≥40). Multilevel log binomial regression analyses were performed to assess the effect of BMI category on the risk of superficial, deep (including organ-space) and total SSI.Results:Of the 387,919 included patients (ranging from 2,616 for laparoscopic appendectomy to 119,834 for total hip prosthesis), 3,676 (1%) were underweight, 116,778 (30%) had normal weight, 154,339 (40%) were overweight, 104,288 (27%) had obesity, and 8,838 (2%) were morbidly obese. A trend of increasing risk of SSI when BMI increased from normal to morbidly obese was observed for almost all surgery types. The increase was most profound in surgeries with clean wounds, with relative risks for morbidly obese patients ranging up to 7.8 (95% CI, 6.0–10.2) for deep SSI in total hip prosthesis. In chest and abdominal surgeries, the impact was larger for superficial SSI than for deep SSI.Conclusions:The results of our research provide evidence for the need of preventive programs targeting SSI in overweight and obese patients, as well as for the prevention of obesity in the general population.

Sign in / Sign up

Export Citation Format

Share Document