Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Elective Colon and Rectal Surgery Differ in Risk Factors for Wound Infection: Results of Prospective Surveillance Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients Risk factors for surgical site infection after low transverse cesarean section. Surgical site infections following operative management of cervical spondylotic myelopathy: prevalence, predictors of occurence, and influence on peri-operative outcomes Postoperative Surgical Site Infections in Patients Undergoing Spinal Tumor Surgery: Incidence and Risk Factors Standardized incidence rates of surgical site infection: a multicenter study in Thailand. Procedure-specific surgical site infection rates and postdischarge surveillance in Scotland. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Risk factors for surgical site infections in neurosurgery patients with antibiotic prophylaxis. Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Surgical site infection in children: prospective analysis of the burden and risk factors in a sub-Saharan African setting. Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry. An operating surveillance system of surgical-site infections in The Netherlands: results of the PREZIES national surveillance network. Preventie van Ziekenhuisinfecties door Surveillance. Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia. Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012. Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: a prospective randomized double-blind controlled trial Surgical site infection: an observer-blind, randomized trial comparing electrocautery and conventional scalpel. Predictors of Hospital Readmission and Surgical Site Infection in the United States, Denmark, and Japan: Is Risk Stratification a Universal Language? The incidence and risk factors for surgical site infection after clean spinal operations: A prospective cohort study and review of the literature Intraoperative Fraction of Inspired Oxygen Is a Modifiable Risk Factor for Surgical Site Infection after Spinal Surgery
BACKGROUND  Surgical site infections ( SSIs ) are complications of surgery that cause significant postoperative morbidity . SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets . OBJECTIVES We aim ed to address a number of objectives . Firstly , identify risk factors for SSI , criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance ( PDS ) . Secondly , test the importance of risk factors for SSI in surveillance data bases and investigate interactions between risk factors . Thirdly , investigate and vali date different definitions of SSI . Lastly , develop models for making risk-adjusted comparisons between hospitals . DATA SOURCES A single hospital surveillance data base was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service data base to address objective 4 . STUDY DESIGN There were four elements to the research : ( 1 ) systematic review s of risk factors for SSI ( two review ers assessed titles and abstract s of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale ) ; ( 2 ) assessment of agreement between four SSI definitions ; ( 3 ) validation of definitions of SSI , quantifying their ability to predict clinical outcomes ; and ( 4 ) development of operation-specific risk models for SSI , with hospitals fitted as r and om effects . RESULTS Review s of SSI risk factors other than established SSI risk indices identified other risk ; some were operation specific , but others applied to multiple operations . The factor most commonly identified was duration of preoperative hospital stay . The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution . There was wide variation in SSI rate ( SSI% ) using different definitions . Over twice as many wounds were classified as infected by one definition only as were classified as infected by both . Different SSI definitions also classified different wounds as being infected . The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes . This finding is paradoxical given the poor agreement between definitions . Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both . Risk factors fitted in multivariable models and their effects , including age and gender , varied by surgical procedure . Operative duration was an important risk factor for all operations , except for hip replacement . Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers . The American Association of Anesthesiologists class was a consistent risk factor for most operations . CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined . SSI definitions varied between surveillance programmes and potentially between hospitals . Different definitions do not have good agreement , but the definitions have similar ability to predict outcomes influenced by SSI . Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures . There was no evidence for effect modification by hospital . Estimates of SSI% should be disseminated within institutions to inform infection control . Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care . Future research should focus on developing an SSI definition that has satisfactory psychometric properties , that can be applied in everyday clinical setting s , includes PDS and is formulated to detect SSIs that are important to patients or health services . FUNDING The National Institute for Health Research Technology Assessment programme Objective : The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection ( SSI ) in both elective colon and rectal surgery . Summary Background Data : SSI is a frequent complication after elective colorectal resection . The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together , without differentiating the type of colorectal surgery performed . However , rectal surgery may have a higher risk for SSI , and identifying risk factors that are more specific to each procedure would be more predictive . Methods : We conducted prospect i ve SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004 . The data for colon and rectal surgeries were collected separately . The outcome of interest was incisional SSI . Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery . Results : A total of 556 colorectal resections , consisting of 339 colon and 217 rectal surgeries , were admitted to the program . The incisional SSI rates in colon and rectal surgeries were 9.4 % and 18.0 % , respectively ( P = 0.0033 ) . Risk factors for developing incisional SSI in colon surgery were ostomy closure ( OR = 7.3 ) and lack of oral antibiotics ( OR = 3.3 ) , while in rectal surgery , risk factors were preoperative steroids ( OR = 3.7 ) , preoperative radiation ( OR = 2.8 ) , and ostomy creation ( OR = 4.9 ) . Conclusions : Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI . SSI surveillance for such surgeries should be performed separately , as this should lead to more efficient identification of risk factors and a reduction in SSI Objective To identify the risk factors for surgical site infection ( SSI ) in patients undergoing elective resection of the colon and rectum . Summary Background Data SSI causes a substantial number of deaths and complications . Determining risk factors for SSI may provide information on reducing complications and improving outcome . Methods The authors performed a prospect i ve study of 2,809 consecutive patients undergoing elective colorectal resection via laparotomy between February 1995 and December 1998 at a single institution . The outcome of interest was SSI , which was classified as being incisional or organ/space with or without clinical leakage . A likelihood ratio forward regression model was used to assess the independent association of variables with SSIs . Results The overall SSI , incisional SSI , and organ/space SSI with and without clinical anastomotic leakage rates were 4.7 % , 3 % , 2 % , and 0.8 % , respectively . Risk factors for overall SSI were American Society of Anesthesiology ( ASA ) score 2 or 3 ( odd ratio [ OR ] = 1.7 ) , male gender ( OR = 1.5 ) , surgeons ( OR = 1.3–3.3 ) , types of operation ( OR = 0.3–2.1 ) , creation of ostomy ( OR = 2.1 ) , contaminated wound ( OR = 2.9 ) , use of drainage ( OR = 1.6 ) , and intra- or postoperative blood transfusion ( 1–3 units , OR = 5.3 ; ≥4 units , OR = 6.2 ) . However , SSIs at specific sites differed from each other with respect to the risk factors . Among a variety of risk factors , only blood transfusion was consistently associated with a risk of SSI at any specific site . Conclusions In addition to ASA score and surgical wound class , blood transfusion , creation of ostomy , types of operation , use of drainage , sex , and surgeons were important in predicting SSIs after elective colorectal resection BACKGROUND Independent risk factors for surgical site infection ( SSI ) after cesarean section have not been well documented , despite the large number of cesarean sections performed and the relatively common occurrence of SSI . OBJECTIVE To determine independent risk factors for SSI after low transverse cesarean section . DESIGN Retrospective case-control study . SETTING Barnes-Jewish Hospital , a 1,250-bed tertiary care hospital . PATIENTS A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001 . METHODS Using the International Classification of Diseases , Ninth Revision , Clinical Modification diagnosis codes for SSI or wound complication and /or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department , we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section .  Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention 's National Nosocomial Infections Surveillance System . Control patients without SSI or endomyometritis were r and omly selected from the population of patients who underwent cesarean section . Independent risk factors for SSI were determined by logistic regression . RESULTS SSIs were identified in 81 ( 5.0 % ) of 1,605 women who underwent low transverse cesarean section . Independent risk factors for SSI included development of subcutaneous hematoma after the procedure ( adjusted odds ratio [ aOR ] , 11.6 [ 95 % confidence interval [ CI ] , 4.1 - 33.2 ] ) , operation performed by the university teaching service ( aOR , 2.7 [ 95 % CI , 1.4 - 5.2 ] ) , and a higher body mass index at admission ( aOR , 1.1 [ 95 % CI , 1.0 - 1.1 ] ) . Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI ( aOR , 0.2 [ 95 % CI , 0.1 - 0.5 ] ) . Use of staples for skin closure was associated with a marginally increased risk of SSI . CONCLUSIONS These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery Purpose Studies have examined  infection rates following spine surgery  and their relationship to post-operative complications and increased length of stay . Few studies , however , have investigated predictors of infection , specifically in the setting of operative intervention for cervical spondylotic myelopathy ( CSM ) . This study aims to identify the incidence and factors predictive of infection amongst this cohort . Methods This study performed a retrospective review of the prospect ively collected American College of Surgeons National Surgical Quality Improvement Program ( NSQIP ) data base . Patients included those treated surgically for CSM ( ICD-9 code 721.1 ) from 2010 to 2012 . Patient demographics and surgical data were collected with outcome variables including the occurrence of one of the following surgical site infections ( SSIs ) within 30 days of index operation : superficial SSI , deep incisional SSI , and organ/space SSI . Results 3057 patients were included in this analysis .  Overall infection rate was 1.15 % ( 35/3057 ) , of which 54.3 % ( 19/35 ) were superficial SSIs , 28.6 % ( 10/35 ) were deep incisional SSI , and 20 % ( 7/35 ) were peri-spinal SSI . Logistic regression revealed factors associated with SSI included : higher BMI [ OR 1.162 ( CI 1.269–1.064 ) , p = 0.001 ] and operative time ≥208 min [ OR 4.769 ( CI 20.220–1.125 ) , p = 0.034 ] . Conclusions The overall SSI rate for the examined CSM cohort was 1.15 % . This study identified increased BMI and operative time ≥208 min as predictors of infection in surgical CSM patients . This information should be carefully considered in delivering patient education and future efforts to optimize risk in CSM patients indicated for surgical intervention Study Design . We conducted a retrospective , case control study on patients undergoing surgery for spinal tumors . Objective . Our aim was to determine the incidence and to identify risk factors for surgical site infections ( SSIs ) in patients undergoing surgery for spinal tumors . Summary of Background Data . SSIs after spinal tumor surgery may be particularly devastating as they may add to substantial surgical morbidity and may further exacerbate already existing neurologic deficits . Incidence and risk factors predisposing to SSIs in patients undergoing surgery for spinal tumors are not well studied yet . Methods . Between January 1995 and February 2008 , 971 procedures for spinal tumors were performed on 739 patients . Excluding sacral tumors from the current study , 895 procedures on 678 patients were review ed to identify those cases with SSIs . Furthermore , 65 infected cases and a r and omly selected subset of 162 controls were analyzed by logistic regression modeling to identify the risk factors associated with SSIs . Results . There were 678 patients that were included in this study with 364 men ( 54 % ) and 314 women ( 46 % ) , with an average age of 47.2 year . Sixty-five patients who developed SSIs underwent a total of 162 procedures including 78 procedures for wound debridement and washout . The incidence of SSIs was 8.89 % for primary nonbony spinal tumors , 9.5 % for metastatic spinal tumors , and 13.7 % for primary bony spinal tumors . Staphylococcus aureus was the most commonly isolated organism ( n = 22 of 65 , 33 % ) . In the multivariate logistic regression model , previous spinal surgeries , complex plastic closures , increasing number of comorbidities , presence of a hospital acquired infection at the time of a previous surgery , and increasing duration of hospital stay during primary surgery were significantly associated with increased likelihood of developing postoperative SSIs . Conclusion . Surgery for spine tumors appears to be associated with a higher incidence of SSI than nontumor spine surgery . Identification of perioperative risk factors will help delineate this subset of patients with high risk for developing SSIs thus potentially allowing perioperative modification for such factors , which may lead to an overall better clinical outcome and patient satisfaction BACKGROUND No previous multicenter data regarding the incidence of  surgical site infection ( SSI ) are available in Thail and . The magnitude of the problem result ing from SSI at the national level could not be assessed . The purpose of this study was to estimate the incidence of SSI in 9 hospitals , together with patterns of surgical antibiotic prophylaxis , risk factors for SSI , and common causative pathogens . METHODS A prospect i ve data collection among patients undergoing surgery in 9 hospitals in Thail and was conducted . The National Nosocomial Infection Surveillance ( NNIS ) system criteria and method were used for identifying and diagnosing SSI . The SSI rates were benchmarked with the NNIS report by means of indirect st and ardization and reported in terms of st and ardized infection ratio ( SIR ) . Antibiotic prophylaxis was categorized into preoperative , intraoperative , and postoperative . Risk factors for SSI were evaluated using multiple logistic regression models . RESULTS From July 1 , 2003 , to February 29 , 2004 , the study included 8764 patients with 8854 major operations and identified 127 SSIs , yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 ( 95 % CI : 0.5 - 0.8 ) . Of these , 35 SSIs ( 27.6 % ) were detected postdischarge . The 3 most common operative procedures were cesarean section , appendectomy , and hysterectomy . The 3 most common pathogens isolated were Escherichia coli , Staphylococcus aureus , and Pseudomonas aeruginosa , which accounted for 15.3 % , 8.5 % , and 6.8 % of infections , respectively . The 3 most common antibiotics used for prophylaxis were ampicillin/amoxicillin , cefazolin , and gentamicin . The proportion of types of antibiotic prophylaxis administered were 51.6 % preoperative , 24.3 % intraoperative , and 24.1 % postoperative . Factors significantly associated with SSI were high degree of wound contamination , prolonged preoperative hospital stay , emergency operation , and prolonged duration of operation . CONCLUSION Overall SSI rates were less than the average NNIS rates . The causative pathogens of SSI were different from those of other reports . There was a crucial proportion of operations that did not comply with the antibiotic guidelines . The risk factors for SSI identified in this study were consistent with most other reports OBJECTIVE To investigate the impact of  postdischarge surveillance ( PDS )  on surgical-site infection ( SSI ) rates for selected surgical procedures in acute care hospitals in Scotl and . DESIGN Prospect i ve surveillance of SSI after selected surgical procedures . SETTING The Scottish Surveillance of Healthcare Associated Infection Programme ( SSHAIP ) , which is based on the methodology of the Centers for Disease Control and Prevention ( CDC ) National Nosocomial Infections Surveillance system ( NNIS ) . Thirty-two of 46 acute care hospitals throughout Scotl and contributed data to SSHAIP for this study . METHODS Data were from 21,710 operations that took place between April 1 , 2002 , and June 30 , 2004 ; nine categories of surgical procedures were analyzed . CDC NNIS system definitions and methods were used for SSI PDS . PDS is a voluntary component of the m and atory SSI surveillance program in Scotl and .  PDS was categorized as none , passive , active without direct observation , and active with direct observation . RESULTS From our study information , PDS data were available for 12,885 operations ( 59 % ) . A total of 2,793 procedures ( 13 % ) were associated with passive PDS and 10,092 ( 46 % ) with active PDS . The SSI rate among the 8,825 operations with no PDS was 2.61 % ( 95 % confidence interval [ CI ] , 2.3%-3.0 % ) , which was significantly lower than the SSI rate found among the 12,885 operations for which PDS was performed ( 6.34 % [ 95 % CI , 5.9%-6.8 % ] ) . For breast surgery , cesarean section , hip replacement , and abdominal hysterectomy , the rate of SSI when PDS was performed was significantly higher than that when PDS was not performed ( P<.01 for each procedure ) . No differences in SSI rates were found for surgery to repair fractured neck of the femur or for knee replacement . SSI rates were examined according to procedure type , performance of PDS , and NNIS risk index ; rates of SSI increased with NNIS risk index within procedure group and PDS group . Logistic regression analyses confirmed that procedure type , performance of PDS , and NNIS risk index were all statistically independent predictors of report of an SSI ( P<.05 ) . CONCLUSIONS This Scottish national data set incorporates a substantial amount of PDS data . We recommend a procedure-specific approach to PDS , with direct observation of patients after breast surgery , cesarean section , and hysterectomy , for which the length of stay is typically short . Readmission surveillance may be adequate to detect most SSIs after orthopedic surgery or vascular surgery , for which the length of stay is typically longer HYPOTHESIS Infectious complications are the main causes of postoperative morbidity in abdominal surgery . Identification of risk factors , which could be avoided in the perioperative period , may reduce the rate of postoperative infectious complications . DESIGN A data base was established from 3 prospect i ve , r and omized , multicenter studies . Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio ( OR ) . SETTING Multicenter studies ( ie , private medical centers , institutional hospitals , and university hospitals ) . PATIENTS From June 1982 to September 1996 , a data base was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery .  MAIN OUTCOME MEASURES The dependent variables studied included surgical site infection ( SSI ) ( divided into parietal and deep infectious complications with or without fistulas ) and global infectious complications ( SSI and extraparietal and abdominal infectious complications ) . RESULTS The rate of global infectious complications was 13.3 % ; SSI , 4.05 % ; parietal infectious complications , 2.2 % ; deep infectious complications with fistulas , 2.18 % ; and deep infectious complications without fistulas , 1.38 % . In multivariate analysis , the following 7 independent risk factors for global infectious complications have been identified : age ( 60 - 74 years , OR , 1.64 ; > or=75 years , OR , 1.45 ) ; being underweight ( OR , 1.51 ) ; having cirrhosis ( OR , 2.45 ) , having a vertical abdominal incision ( OR , 1.66 ) ; having a suture placed or an anastomis of the bowel ( OR , 1.48 ) in the digestive tract ; having a prolonged operative time ( 61 - 120 minutes , OR , 1.66 ; 121 minutes , OR , 2.72 ) ; and being categorized as having a class 4 surgical site ( ie , obese patients or having a risk factor of a healing defect ) ( OR , 1.66 ) .  Ceftriaxone sodium therapy  was identified as a protective factor ( OR , 0.43 ) . In multivariate analysis , the following 5 independent risk factors for SSI have been identified : the existence of a preoperative cutaneous abscess or cutaneous necrosis ( OR , 4.75 ) , having a suture placed or an anastomosis of the bowel ( OR , 1.82 ) in the digestive tract , having postoperative abdominal drainage ( OR , 2.15 ) , undergoing a surgical procedure for the treatment of cancer ( OR , 1.74 ) , and receiving curative anticoagulant therapy ( OR , 3.33 ) postoperatively . CONCLUSIONS Our data show that risk factors for SSI and for global infectious complications are disparate . Indeed , only the placement of a suture or having an anastomosis of the bowel in the digestive tract is a risk factor for both SSI and global infections . Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications BACKGROUND This prospect i ve study aim ed to determine the spectrum and the main risk factors of surgical site infection ( SSI )  after neurosurgical procedures in our clinic . METHODS Consecutive patients undergoing neurosurgery between November 1 , 2001 , and November 1 , 2002 , were recruited for the study . All patients were followed for a minimum of 2 weeks postoperatively and all SSIs were recorded . The complete medical records of each case were review ed , and data on 14 possible risk factors were extracted . Statistical analyses were performed to identify the risk factors for SSIs . RESULTS A total of 31 postoperative SSIs were identified among 503 cases included in the study , with a result ing overall infection rate of 6.2 % . The risk of SSI was increased by age ( odds ratio [ OR ] , 1.1 ; 95 % confidence interval [ CI ] , 1.0 - 1.1 ; P = .039 ) , operation type such as " shunt operations " ( OR , 670.4 ; 95 % CI , 2.6 - 171123.1 ; P = .021 ) , presence of foreign body ( OR , 141.0 ; 95 % CI , 2.5 - 7925.9 ; P = .016 ) , presence of diabetes mellitus ( OR , 24.3 ; 95 % CI , 2.1 - 284.9 ; P = .011 ) , and intracranial pressure monitoring ( OR , 4878.9 ; 95 % CI , 23.8 - 1001229 ; P = .002 ) . The predominantly isolated microorganisms in patients with SSIs were Staphylococcus aureus ( 22 [ 71.0 % ] ) , Acinetobacter baumanii ( 5 [ 16.1 % ] ) , and Staphylococcus epidermidis ( 4 [ 12.9 % ] ) . CONCLUSIONS SSIs remain an important problem in neurosurgery . Identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality , morbidity , and health care costs of neurosurgery patients BACKGROUND CONTEXT Surgical site infection ( SSI ) is one of the most serious complications of spine surgery . Its predisposing factors , especially in routine surgeries , are less reported . However , a number of patient- and procedure-related risk factors could be avoided or at least determined preoperatively . Moreover , the patient-specific risk for SSI could be estimated before the elective surgery . PURPOSE The aim of the present study was to analyze the preoperatively determinable risk factors for SSI in patients who require elective routine surgery related to lumbar disc degeneration and to build a multivariable model for the individual risk prediction . STUDY DESIGN Analysis of prospect ively collected st and ardized clinical data and the validation of the results on an independent prospect i ve cohort were performed . PATIENT SAMPLE One thous and thirty ( N=1,030 ) patients were included in the study . All subjects underwent primary lumbar single- or two-level decompression , microdiscectomy , or instrumented fusion .  OUTCOME MEASURES Occurrence of an SSI defined according to the current Centers for Disease Control and Prevention guidelines that required surgical or nonsurgical therapy . METHODS The effect of preoperative patient characteristics , comorbidities , disease history , and invasiveness of the elective surgery on the risk of SSI was determined in uni- and multivariate logistic regression models in the test cohort ( N=723 ) . The performance of the final multivariable regression model was assessed by measuring its discriminative ability ( c-index ) in receiver operating characteristic analysis . Performance of the multivariable risk estimation model was tested on the validation ( N=307 ) cohort . RESULTS The prevalence of SSI was 3.5 % and 3.9 % in the test and in the validation cohorts , respectively . The final multivariable regression model predictive ( p=.003 ) for SSI contained the patient 's age , body mass index ( BMI ) , and the presence of 5 comorbidities , such as diabetes , ischemic heart disease , arrhythmia , chronic liver disease , and autoimmune disease as risk factors . The c-index of the model was 0.71 , showing good discriminative ability , and it was confirmed by the data of the independent validation cohort ( c=0.72 ) . CONCLUSIONS Predisposing factors for SSI were older age , higher BMI , and the presence of certain comorbidities in the present study . The cumulative number of risk factors significantly associated with the increasing risk for an SSI ( p<.0001 ) . Our model needs further validation but it may be used for individual risk assessment and reduction in the future BACKGROUND The Victorian Infection Control Surveillance Project ( VICSP ) is a multicenter collaborative surveillance project established by infection control practitioners . Five public hospitals contributed data for patients undergoing coronary artery bypass graft ( CABG ) surgery .  OBJECTIVE To determine the aggregate and comparative interhospital surgical-site infection ( SSI ) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group . METHOD Each institution used st and ardized definitions of SSI , risk adjustment , and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention . Data on potential risk factors were prospect ively collected . RESULTS For 4,474 patients undergoing CABG surgery , the aggregate SSI rate was 7.8 infections per 100 procedures ( 95 % confidence interval [ CI95 ] , 7.0 - 8.5 ) , with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures . Multivariate risk factor analysis demonstrated age ( odds ratio [ OR ] , 1.02 ; CI95 , 1.01 - 1.04 ; P < .001 ) , obesity ( OR , 1.8 ; CI95 , 1.4 - 2.3 ; P < .001 ) , and diabetes mellitus ( OR , 1.6 ; CI95 , 1.2 - 2.1 ; P < .001 ) as independent predictors of SSI . Three hundred thirty-four organisms were isolated from 296 SSIs . Of the total SSIs , methicillin-resistant Staphylococcus aureus was isolated from 32 % , methicillin-sensitive S. aureus from 24 % , gram-negative bacilli ( eg , Enterobacter and Escherichia coli ) from 18 % , and miscellaneous organisms from the remainder . CONCLUSION We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI . VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery BACKGROUND Surgical site infections ( SSI ) add substantially to the morbidity of surgical patients . Our hypothesis was that the SSI rate is high in our setting , but there were no data regarding the prevalence and risk factors . METHODS Three hundred twenty-two children who had surgery ( elective 144 , emergency 178 ) between January , 2001 and September , 2005 were studied prospect ively . All patients with clean-contaminated , contaminated , and dirty incisions received prophylactic antibiotics . Data were collected using a tool that captured demographics , diagnosis , co-morbid conditions , type of surgical incision , nature of surgery , type of anesthesia , use of perioperative antibiotics , and duration of surgery . Information also was collected postoperatively on the development of SSI , type of infection , associated signs , the day the infection was identified , the findings in cultures of swabs from infected incisions , duration of hospital stay , and outcome . The chi-square test for categorical variables was used to test for significance of association . The p value for significance was set at 0.05 . RESULTS Seventy-six patients ( 23.6 % ) consisting of 40 boys and 36 girls developed SSI .  The median age was nine months ( range , 2 days-12 years ) for those who developed SSI and 15 months ( range , 1 day-13 years ) for those who did not . The SSI rate was 14.3 % in clean incisions , 19.3 % in clean-contaminated incisions , 27.3 % in contaminated incisions , and 60 % in dirty incisions ( p < 0.05 ) . The infection rate was 25.8 % in emergency procedures and 20.8 % in elective procedures ( p > 0.05 ) . The infection rate was 31 % in operations lasting > or= 2 h and 17.3 % in operations lasting < 2 h ( p < 0.05 ) . Infection was detected before the eighth postoperative day in 56 of the patients ( 74.6 % ) with SSI , and bacteria were cultured from the incision in 32 patients ( 42.7 % ) . The average length of stay was 26.1 days ( range , 8 - 127 days ) in patients with SSI and 18.0 days ( range , 1 - 99 days ) in those without SSI ( p < 0.05 ) . The mortality rate of patients with SSI was 10.5 % , with six of the eight deaths related directly to the SSI , compared with a mortality rate of 4.1 % in patients without SSI ( p < 0.05 ) . CONCLUSION The burden of SSI in this setting is high . The degree of incisional contamination and a long duration of surgery ( > or= 2 h ) are important risk factors BACKGROUND CONTEXT The impact of surgical site infection ( SSI )  is substantial . Although previous study has determined relative risk and odds ratio ( OR ) values to quantify risk factors , these values may be difficult to translate to the patient during counseling of surgical options . Ideally , a model that predicts absolute risk of SSI , rather than relative risk or OR values , would greatly enhance the discussion of safety of spine surgery . To date , there is no risk stratification model that specifically predicts the risk of medical complication . PURPOSE The purpose of this study was to create and vali date a predictive model for the risk of SSI after spine surgery . STUDY DESIGN This study performs a multivariate analysis of SSI  after spine surgery using a large prospect i ve surgical registry . Using the results of this analysis , this study will then create and vali date a predictive model for SSI after spine surgery . PATIENT SAMPLE The patient sample is from a high- quality surgical registry from our two institutions with prospect ively collected , detailed demographic , comorbidity , and complication data . OUTCOME MEASURES An SSI that required return to the operating room for surgical debridement . MATERIAL S AND METHODS Using a prospect ively collected surgical registry of more than 1,532 patients with extensive demographic , comorbidity , surgical , and complication details recorded for 2 years after the surgery , we identified several risk factors for SSI after multivariate analysis . Using the beta coefficients from those regression analyses , we created a model to predict the occurrence of SSI after spine surgery . We split our data into two subsets for internal and cross-validation of our model . We created a predictive model based on our beta coefficients from our multivariate analysis . RESULTS The final predictive model for SSI had a receiver-operator curve characteristic of 0.72 , considered to be a fair measure . The final model has been uploaded for use on SpineSage.com . CONCLUSIONS We present a vali date d model for predicting SSI after spine surgery . The value in this model is that it gives the user an absolute percent likelihood of SSI after spine surgery based on the patient 's comorbidity profile and invasiveness of surgery . Patients are far more likely to underst and an absolute percentage , rather than relative risk and confidence interval values . A model such as this is of paramount importance in counseling patients and enhancing the safety of spine surgery . In addition , a tool such as this can be of great use particularly as health care trends toward pay for performance , quality metrics ( such as SSI ) , and risk adjustment . To facilitate the use of this model , we have created a Web site ( SpineSage.com ) where users can enter patient data to determine likelihood for SSI OBJECTIVES To describe the results of the first year of the Dutch national surveillance of surgical-site infections ( SSIs ) and risk factors , which aims to implement a st and ardized surveillance system in a network of Dutch hospitals , to collect comparable data on SSIs to serve as a reference , and to provide a basic infrastructure for further intervention research . DESIGN Prospect i ve multicenter cohort study . SETTING Acute-care hospitals in The Netherl and s from June 1996 to May 1997 . RESULTS 38 hospitals participated , with a slight over-representation of larger hospitals . Following a total of 18,063 operations , 562 SSIs occurred , of which 198 were deep . Multivariate analysis of pooled procedures shows that age , preoperative length of stay , wound contamination class , anesthesia score , and duration of surgery were independent risk factors for SSI . When analyzed by procedure , the relative importance of these risk factors changed . Bacteriological documentation was available for 56 % of the SSIs ; 35 % of all isolates were Staphylococcus aureus . Multiple regression analysis computed the mean extra postoperative length of stay associated with SSI to be 8.2 days . CONCLUSION The first year of national surveillance has shown that it is feasible to collect comparable data on SSI , which are already used for education , policy , and decision making in the network of participating hospitals . This gives room to effectuate the next aim , namely to use the network as an infrastructure for intervention research . Multivariate analysis shows that feedback on a procedure-specific level is important OBJECTIVES To estimate the frequency of and risk factors for surgical-site infections ( SSIs ) in Bolivia , and to study the performance of the National Nosocomial Infections Surveillance ( NNIS ) System risk index in a developing country . DESIGN A prospect i ve study with patient follow-up until the 30th postoperative day . SETTING A general surgical ward of a public hospital in Santa Cruz , Bolivia . PATIENTS Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed . RESULTS Follow-up was complete for 91.5 % of 376 surgical procedures . The overall SSI rate was 12 % . Thirty-four ( 75.6 % ) of the 45 SSIs were culture positive . A logistic regression model retained an American Society of Anesthesiologists score of more than 1 ( odds ratio [ OR ] , 1.87 ) , a not-clean wound class ( OR , 2.28 ) , a procedure duration of more than 1 hour ( OR , 1.81 ) , and drain ( OR , 1.98 ) as independent risk factors for SSI . There was no significant association between the NNIS System risk index and SSI rates . However , a " local " risk index constructed with the above cutoff points showed a linear trend with SSI ( P < .001 ) and a relative risk of 3.18 for risk class 3 versus a class of less than 3 . CONCLUSIONS SSIs cause considerable morbidity in Santa Cruz . Appropriate nosocomial infection surveillance and control should be introduced . The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting , but a risk score based on local cutoff points performed substantially better BACKGROUND CONTEXT The incidence of surgical site infection ( SSI ) following posterior cervical surgery has been reported as high as 18 % in the literature . Few large studies have specifically examined posterior cervical procedures . PURPOSE The study aims to examine the incidence , timing , and risk factors for SSI following posterior cervical surgery . DESIGN This is a retrospective cohort study of prospect ively collected data in a national surgical outcomes data base . PATIENT SAMPLE The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project ( ACS NSQIP ) Participant Use Data File . OUTCOME MEASURES The 30-day rate of postoperative SSI , timing of diagnosis , and associated risk factors were determined . METHODS The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012 . Thirty-day readmission data were obtained for 2011 - 2012 . The incidence and timing of SSI were determined . Multivariable logistic regression analysis was then performed to identify significant risk factors . RESULTS Of the 5,441 patients identified as having undergone posterior cervical surgery , 3,724 had a posterior cervical decompression , 1,310 had a posterior cervical fusion , and 407 underwent cervical laminoplasty .  Surgical site infection within 30 days was identified in 160 patients ( 2.94 % ) , with 80 of those cases being superficial SSI . There was no significant difference in SSI rate among the three procedure groups . The average time for diagnosis of SSI was over 2 weeks . In 2011 - 2012 , 36.9 % of patients with SSI were readmitted within 30 days . Several significant predictors of SSI were identified in univariate analysis , including body mass index ( BMI ) > 35 , chronic steroid use , albumin <3 , hematocrit <33 , platelets < 100 , higher American Society of Anesthesiologists class , longer operative time , and longer hospital admission . Independent risk factors , including BMI > 35 ( odds ratio [OR]=1.78 , p=.003 ) , chronic steroid use ( OR=1.73 , p=.049 ) , and operative time > 197 minutes ( OR=2.08 , p=.005 ) , were identified in multivariable analysis . CONCLUSIONS Optimization of preoperative nutritional status , serum blood cell counts , and operative efficiency may lead to a reduction in SSI rates . Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk INTRODUCTION Spine surgery is known to have a high risk of surgical site infection ( SSI ) . Multiple studies have looked into the risk factors and incidence of SSI during elective surgery , but only two retrospective studies have specifically evaluated SSI during surgery following spine trauma . MATERIAL S AND METHODS This work was based on a prospect i ve cohort study that included all the patients operated on for spinal trauma at 13 French hospitals over a three-month period . The main endpoint was the occurrence of a SSI during the three-month period . Patients with multiple trauma or open fractures were excluded from the study . RESULTS Of the 169 patients re-examined after a minimum of three months , six had had an acute SSI ( 3.55 % ) . The following factors were significantly related to a SSI : age , ASA score , diabetes , procedure duration , delay elapsed between accident and procedure , number of levels fused , bleeding and prolonged presence of urinary catheter . DISCUSSION Our results were consistent with the published infection rates of 2 to 10 % . The risk factors identified have all been described in previous studies on elective spine surgery . LEVEL OF EVIDENCE Level IV , prospect i ve cohort study Background A prophylactic antibiotic is recommended in open cholecystectomy surgeries , but in laparoscopic cholecystectomies such prophylaxis is controversial . Recent review s have not found conclusive evidence that routine prophylaxis , especially in low risk patients , is effective . This clinical trial was undertaken to evaluate the efficacy of cefazolin in reducing surgical site infection SSI in laparoscopic cholecystectomies in a sample not screened for high or low risk patients . Methods A r and omized double-blind controlled trial was conducted in a single university hospital . Scheduled cholecystectomy patients without selection for patient risk factors were r and omized into two groups . Pre-operatively , group A patients received a placebo of 10 ml isotonic sodium chloride , and group B patients received 1 g of cefazolin as a prophylactic antibiotic . All patients underwent a st and ard laparoscopic cholecystectomy , and were followed up for at least 30 days . Results Two hundred ninety-nine patients were r and omized ( 149 in group A and 150 in group B ) .  SSI occurred in seven patients ( 2.34 % ) , five ( 1.67 % ) in the placebo group , and two ( 0.67 % ) in the prophylactic antibiotic group . The difference was not statistically significant ( p value = 0.512 ) , and no specific risk factors for post-operative infection were identified . Conclusions A single dose of preoperative prophylactic cefazolin has no significant benefit in reducing the incidence of SSI in laparoscopic cholecystectomy . Whether or not to use a prophylactic depends on the individual patient , and the consideration of the attending surgeon AIM To evaluate the incidence of surgical site infection ( SSI ) based on the type of scalpel used for incisions in the skin and in subcutaneous tissues . METHODS Observer-blind , r and omized equivalence clinical trial with two arms ( electrocautery versus conventional scalpel ) which evaluated 133 women undergoing elective abdominal gynecologic oncology surgery . A simple r and omization stratified by body mass index ( BMI : 30 kg/m(2 ) ) was carried out . Women were evaluated at 14 and 30 days following the operation . A multivariate analysis was performed in order to check whether the type of scalpel would be a risk factor for SSI . RESULTS Group arms were balanced for all variables , excepted for surgical time , which was significantly higher in the electrocautery group ( mean : 161.1 versus 203.5 min , P = 0.029 ) . The rates of SSI were 7.4 % and 9.7 % , respectively , for the conventional scalpel and electrocautery groups ( P = 0.756 ) . The exploratory multivariate model identified body mass index ≥30 kg/m(2 ) ( OR = 24.2 , 95 % CI : 2.8 - 212.1 ) and transverse surgical incision ( OR = 8.1 , 95 % CI : 1.5 - 42.6 ) as independent risk factors for SSI . The type of scalpel used in surgery , when adjusted for these variables and the surgery time , was not a risk factor for SSI . CONCLUSION This study showed that the SSI rates  for conventional scalpel and electrocautery were not significantly different . These results were consistent with others reported in the literature and would not allow a surgeon to justify scalpel choice based on SSI . TRIAL NUMBER NCT01410175 ( Clinical Trials - NIH ) Study Design . Retrospective review of three spine surgery data bases . Objectives . The purpose of the present study is to determine whether predictors of  hospital readmission and surgical site infection ( SSI )  after lumbar fusion will be the same in United States , Denmark , and Japan . Summary of Background Data . Because clinical decision making becomes more data driven , risk stratification will be crucial to minimize complications . Spine surgeons worldwide face this issue , leading to parallel efforts to address risk stratification . This raises the question as to whether pooled data would be valuable and whether models generated in one country would be applicable to other population s. Methods . Predictors of SSI and 30-day readmission from three prospect i ve data bases ( National Neurosurgery Quality and Outcomes Data base [ N2QOD ] N = 2653 , DaneSpine N = 1993 , Japan Multicenter Spine Data base [ JAMSD ] N = 3798 ) were determined and compared to identify common or divergent predictive risks . Results . Predictive variables differed in the three data bases , for both readmission and SSI . Factors predictive for hospital readmission were American Society of Anesthesiologists ( ASA ) grade in N2QOD ( P = 0.013 , odds ratio [ OR ] 2.08 ) , fusion levels in DaneSpine ( P = 0.005 , OR 1.67 ) , and sex in JAMSD ( P = 0.001 , OR = 2.81 ) . Associated differences in demographics and procedural factors included mean ASA grade ( N2QOD = 2.45 , JAMSD = 1.72 ) and fusion levels ( N2QOD = 1.39 , DaneSpine = 1.52 , JAMSD = 1.34 ) . For SSI , sex ( P = 0.000 , OR = 3.30 ) , diabetes ( P = 0.000 , OR = 2.90 ) , and length of stay ( P = 0.000 , OR = 1.02 ) were predictive in JAMSD . No predictors were identified in N2QOD or DaneSpine . Conclusion . Predictors of SSI and hospital readmission differ in the United States , Denmark , and Japan , suggesting that risk stratification models may need to be population specific or adjusted . Some differences in measured parameters exist in the three data bases analyzed ; however , patient and procedure selection also appear to differ and may limit the ability to directly pool data from different regions . Therefore , risk stratification models developed in one country may not be directly applicable to other countries . Level of Evidence : Background : Postoperative infection is one of the most common complications after spine surgeries . In our study , surgical site infection ( SSI ) is described as ; superficial ( i.e. , skin and subcutaneous tissues ) and deep ( i.e. , fascia and muscles ) infections occurring in the short term ( i.e. , 1-month ) after spine surgeries ( Centers for Disease Control and Prevention definition 81.00–81.08 ) . To detect the risk factors for the occurrence of such a complication , studies require a large number of patients , a high quality of data and adequate analysis . In this study , we prospect ively enrolled 987 patients undergoing spinal surgery over a 3 years period . Methods : From November 2010 to November 2013 , 987 patients had a variety of spinal operations that included ; disc herniation , spinal stenosis , spondylolisthesis , fracture-dislocations , spine and spinal cord tumors , and syringomyelia . Patients under the age of 10 , those with a recent history of infection and antibiotherapy , and patients with immunodeficiency disorders were excluded . Results : Of the 987 spine procedures performed , 27 ( 2.73 % ) developed postoperative infections . Multi-variant data analysis indicated that multiple factors correlated with an increased risk of SSI in descending order ; trauma , a past history of diabetes , smoking , being confined to bed , in the perioperative period , mean blood sugar levels above 120 mg/dl , longer lengths of incisions , and longer hospital stay . Conclusion : Considering the preventable nature of most of the factors contributing to SSI , it should be possible to reduce these complications Background : Surgical site infections ( SSI ) after spinal surgery increase morbidity , mortality , length of hospital stay , and costs . Most previously identified risk factors for these infections , such as severity of illness and procedure duration , are not amenable to intervention . This study sought to identify modifiable risk factors associated with SSI after spinal surgery . Methods : This is a case-control study including case identification and review of medical records . A total of 104 patients with SSI after spinal surgery were compared to 104 r and omly selected control patients without SSI after spinal surgery in a 926-bed tertiary care hospital in Baltimore , Maryl and , between April 1 , 2001 and December 31 , 2004 . Results : Multivariate analysis identified independent risk factors for SSI after spinal surgery including prolonged procedure duration ( odds ratio [ OR ] , 4.7 ; 95 % confidence interval [ 95 % CI ] , 1.6–14 ; P < 0.001 ) , American Society of Anesthesiologists score of 3 or greater ( OR , 9.7 ; 95 % CI , 3.7–25 ; P < 0.001 ) , lumbar-sacral operative level ( OR , 2.9 ; 95 % CI , 1.2–7.1 ; P = 0.02 ) , posterior approach ( OR , 3.5 ; 95 % CI , 1.2–9.7 ; P = 0.02 ) , instrumentation ( OR , 2.5 ; 95 % CI , 1.1–6.0 ; P = 0.03 ) , obesity ( OR , 4.0 ; 94 % CI , 1.6–10 ; P < 0.01 ) , razor shaving before surgery ( OR , 3.6 ; 95 % CI , 1.2–11 ; P = 0.02 ) , and intraoperative administered fraction of inspired oxygen of less than 50 % ( OR , 12 ; 94 % CI , 4.5–33 ; P < 0.001 ) . Conclusions : In addition to previously reported risk factors , this study identified intraoperative administered fraction of inspired oxygen of less than 50 % as an independent , modifiable risk factor for SSI after spinal surgery . Intraoperative administration of at least 50 % fraction of inspired oxygen should be tested prospect ively as an intervention to prevent SSI after spinal surgery
Surgical associated factors — preoperative radiation/postoperative blood transfusion , combined anterior/posterior approach , surgical invasiveness , or levels of instrumentation were associated with increased SSI .
There is mixed evidence of age , duration of surgery , surgical team , intraoperative blood loss , dural tear , and urinary tract infection/urinary catheter in association with SSI .
Conclusion : SSIs are associated with many risk factors that can be patient or surgically related .
Objective : To perform a review of SSI risk factors and more specifically , categorize them into patient and surgical factors .