Multivariable Predictors of Postoperative Surgical Site Infection after General and Vascular Surgery: Results from the Patient Safety in Surgery Study
Surgical site infection (SSI) is a potentially preventable complication. We developed and tested a model to predict patients at high risk for surgical site infection.
Data from the Patient Safety in Surgery Study/National Surgical Quality Improvement Program from a 3-year period were used to develop and test a predictive model of SSI using logistic regression analyses.
From October 2001 through September 2004, 7,035 of 163,624 (4.30%) patients undergoing vascular and general surgical procedures at 14 academic and 128 Department of Veterans Affairs (VA) medical centers experienced SSI. Fourteen variables independently associated with increased risk of SSI included patient factors (age greater than 40 years, diabetes, dyspnea, use of steroids, alcoholism, smoking, recent radiotherapy, and American Society of Anesthesiologists class 2 or higher), preoperative laboratory values (albumin<3.5 mg/dL, total bilirubin>1.0 mg/dL), and operative characteristics (emergency, complexity [work relative value units>/=10], type of procedure, and wound classification). The SSI risk score is more accurate than the National Nosocomial Infection Surveillance score in predicting SSI (c-indices 0.70, 0.62, respectively).
We developed and tested an accurate prediction score for SSI. Clinicians can use this score to predict their patient's risk of an SSI and implement appropriate prevention strategies.
Available from: Hadir El-Mahallawy
- "Despite the advances in infection control practice, SSIs still cause substantial morbidity and mortality rates among hospitalized patients and contribute to increased hospitalization and increased consumption of resources and costs . SSIs are the third most common health care associated infections (HAI) accounting for approximately 38% of infections in the surgical patient population . For clean-contaminated and contaminated operative procedures , antibiotic prophylaxis is recommended. "
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ABSTRACT: Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection (SSI) after a clean contaminated cancer surgery. Our aim is to compare the use of two prophylactic antibiotic (PA) regimens as regards efficacy, timing, and cost.
Two hundred patients with gastric, bladder, or colorectal cancer were randomized to receive preoperative PA, group A received penicillin G sodium and gentamicin and group B received clindamycin and amikacin intravenously. The demographic data of patients were collected, and they were observed for wound infections.
Infected wounds occurred in 19 patients with a rate of 9.5%. Highest incidence of SSI was among bladder cancer patients (14.2%); p=0.044. The rate of SSI was 11% in group A, and 8% in group B, p=0.469. The cost of PA administered in group A was significantly less than that of group B (21.96±3.22LE versus 117.05±12.74LE, respectively; p<0.001). SSI tended to be higher among those who had longer time for antibiotic and incision (⩾30min) than those who had shorter time interval (<30min), (13% vs. 6.5%, respectively).
Both penicillin+gentamicin and clindamycin+amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures. In a resource limited hospital, a regimen including penicillin+gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin+amikacin. Timing of PA is effective in preventing SSIs when administered 30min before the start of surgery.
Available from: Patricia A Lohr
- "According to Gould (2012) and Kiernan (2012) these risk factors can be either patient characteristics or perioperative influences. Sangrasi et al (2008) and Neumayer et al (2007) identified patient-related SSI risk factors as age, diabetes, poor nutritional status, immunosuppression, high body mass index (BMI), current infection, and smoking. Perioperative influences include timing and method of hair removal, type of skin preparation, length of operation, and surgical expertise (Rojanapirom, 1992; Gould, 2012). "
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ABSTRACT: The aim of this study was to determine the incidence of surgical site infection (SSI) after vasectomy and to identify associated patient and perioperative risk factors, including the operating room environment (non-ventilated treatment room or ventilated operating theatre). This study used an active 30-day surveillance follow-up programme with telephone interviews and home visits. Patients were recruited over an 18 month period. Demographics, patient details and perioperative procedures were documented on the day of surgery. Patients were telephoned 10 and 30 days post procedure. Of 1,155 patients enrolled, 994 (86%) completed the full 30-day follow-up. Of these, 25 (2.5%) developed an SSI. The mean number of days until presentation with an SSI was 13. No statistically significant difference was found in rates of SSI when vasectomies were undertaken in either ventilated operating theatres or non-ventilated treatment rooms.
Available from: Apas Aggarwal
- "Procedural RVUs correlate highly with surgical complexity.5 Reports have linked increasing surgical complexity (RVUs) to respiratory failure following pediatric surgery,6 surgical site infections following general and vascular surgery,7 and complications following liver resection.8 To our knowledge, there have been no studies linking surgical complexity, as measured by RVUs or any other metric, to outcomes in plastic and reconstructive surgery. "
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Relative value units (RVUs) were developed as a quantifier of requisite training, knowledge, and technical expertise for performing various procedures. In select procedures, increasing RVUs have been shown to substitute well for increasing surgical complexity and have been linked to greater risk of complications. The relationship of RVU to outcomes has yet to be examined in the plastic surgery population.
This study analyzed nearly 15,000 patients from a standardized, multicenter database to better define the link between RVUs and outcomes in this surgical population. The American College of Surgeons' National Surgical Quality Improvement Program was retrospectively reviewed from 2006 to 2010.
A total of 14,936 patients undergoing primary procedures of plastic surgery were identified. Independent risk factors for complications were analyzed using multivariable logistic regression. A unit increase in RVUs was associated with a 1.7% increase in the odds of overall complications and 1.0% increase in the odds of surgical site complications but did not predict mortality or reoperation. A unit increase in RVUs was also associated with a prolongation of operative time by 0.41 minutes, but RVUs only accounted for 15.6% of variability in operative times.
In the plastic surgery population, increasing RVUs correlates with increased risks of overall complications and surgical site complications. While increasing RVUs may independently prolong operative times, they only accounted for 15.6% of observed variance, indicating that other factors are clearly involved. These findings must be weighed against the benefits of performing more complex surgeries, including time and cost savings, and considered in each patient's risk-benefit analysis.
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