Multivariable Predictors of Postoperative Surgical Site Infection after General and Vascular Surgery: Results from the Patient Safety in Surgery Study

ArticleinJournal of the American College of Surgeons 204(6):1178-87 · July 2007with36 Reads
DOI: 10.1016/j.jamcollsurg.2007.03.022 · Source: PubMed
Abstract
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.
    • "SSI is associated with a statistically increase in hospital and ICU readmission, long – term complications of the surgical site and even death [4]. Previous studies have identified multiple risk factors for SSIs, in various types of surgeries, these factors include non-modifiable risk factors such as the presence of diabetes, dyspnea and older age (age ˃ 40 years) and modifiable risk factors such as surgical antibiotic prophylaxis (SAP) which is considered to be of the most important procedures that should be optimized to minimize the risk of SSI [5]. SAP is defined as the preoperative administration of a short course of antibiotics to prevent possible surgical site infections [6]. "
    Dataset · Jan 2016 · Drug and Alcohol Review
    • "SSI is associated with a statistically increase in hospital and ICU readmission, long – term complications of the surgical site and even death [4]. Previous studies have identified multiple risk factors for SSIs, in various types of surgeries, these factors include non-modifiable risk factors such as the presence of diabetes, dyspnea and older age (age ˃ 40 years) and modifiable risk factors such as surgical antibiotic prophylaxis (SAP) which is considered to be of the most important procedures that should be optimized to minimize the risk of SSI [5]. SAP is defined as the preoperative administration of a short course of antibiotics to prevent possible surgical site infections [6]. "
    Full-text · Article · Dec 2015 · Drug and Alcohol Review
    • "These pathophysiological effects that impact the body's ability to heal and recover from ill health have important implications for surgical recovery. A growing body of research indicates that risky drinking prior to surgery can have a detrimental impact on postoperative recovery [19,21222324252627. Rates of risky alcohol use prior to elective surgeries range from 30.0% to 88.5% among otolaryngology surgeries, from 29% to 33% among vascular and thoracic surgeries and from 7.7% to 28.0% among other types of surgery [28]. "
    [Show abstract] [Hide abstract] ABSTRACT: Preoperative alcohol use is associated with an increase in postoperative morbidity and mortality. Short-term abstinence prior to elective surgery has been shown to reduce postoperative risks. Therefore, behavioural intervention (BI) targeting risky drinking may have significant utility in preventing surgical complications. The literature was systematically reviewed to identify the scope and outcomes of BIs aiming to reduce alcohol use in risky drinkers before they underwent surgery. Five databases were searched using PRISMA criteria. Of 1243 studies identified, four met pre-established inclusion criteria: (i) implementation of a BI prior to an elective surgery; (ii) the BI-targeted alcohol use among risky drinkers; and (iii) printed in English. Two studies indicated significant reductions in alcohol use at follow ups, and one study demonstrated reductions in postoperative risks. These findings are encouraging, but in light of methodological limitations, the efficacy of preoperative BIs for risky drinking could not be determined. Future efforts to screen and implement BIs addressing alcohol use in preoperative patients should carefully define risky drinking, allow ample time for recruitment prior to surgery, implement empirically supported interventions, examine the impact of relevant covariates, and consider the statistical power needed to detect change in postoperative complications. Given the strong link between preoperative alcohol use and postoperative risks, additional research on preoperative BIs is critically needed. Existing research suggests several promising directions for research that may enhance future intervention efforts with this high-risk population. [Fernandez AC, Claborn KR, Borsari B. A systematic review of behavioural interventions to reduce preoperative alcohol use. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.
    Full-text · Article · Jun 2015
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