Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection

Appendix I. Initial Risk Factors

Risk Factor Evidence Modifiable? Patient Perioperative Surgeon
Age   N Y    
Gender   N Y    
Body Mass Index II N Y    
Comorbidity Score   N Y    
Diabetes II N Y    
Chronic Lung Disease   N Y    
Chronic Kidney Disease   N Y    
Peripheral vascular disease   N Y    
Prior site irradiation   N Y    
Recent operation   N Y    
Skin carriage of staphylococci   N Y    
Skin disease in the area of infection (eg, psoriasis)   N Y    
Wound Class I N Y    
Emergent Procedure   N Y    
ASA Score I N Y    
Revision/Re-do Operation   N Y    
Pre-Op Hospitalization   N Y    
Hx of MRSA   N Y    
Post-Op Wound Care by Nurse   Y   Y  
Hospitalizations in Prior 12 Months   N Y    
Surgical Site   N Y    
Anesthetic Drugs   Y   Y  
Hx Rheumatologic Disease   N Y    
Previous Surgical Site Infection   N Y    
Instututionalized   N Y    
NNIS Risk Index I N Y    
Glucose Control   Y Y    
Hypocholesterolemia   Y Y    
Preoperative anemia   Y Y    
Postoperative anemia   Y Y    
Remote infection   Y Y    
Malnutrition   Y Y    
Smoking   Y Y    
Outpatient Surgery   Y   Y  
Inpatient Surgery   Y   Y  
Staph Aureus Colonization   Y Y    
Preoperative Shower   Y Y    
Immunosuppressive Drugs Pre-Op   Y Y    
Pre-Op Albumin Level     Y    
Ascites     Y    
Chronic inflammation     Y    
Corticosteroid therapy  w/in 30 Days     Y    
Duration of Surgery (min)   N   Y  
Tourniquet Time   N   Y  
Post-Op Mechanical Ventilation   N   Y  
Laminar Airflow OR   Y   Y  
HEPA Filtered OR   Y   Y  
Laparoscopic Approach I Y   Y  
General Anesthesia   Y   Y  
Post-Op Admit   Y   Y  
ICU Admission Post-Op   Y   Y  
Perioperative Hyperoxia (FiO2 80%)   Y   Y  
Timely Pre-Op Abx I Y   Y  
Appropriate Pre-op Abx II Y   Y  
Discontinuation of Post-Op Abx <24 hr III Y   Y  
Appropriate Intra-Op Re-dosing of Abx   Y   Y  
Lowest Intra-Op Temperature I Y   Y  
Temperature on Arrival to PACU I Y   Y  
Peri-Op Glucose <100   Y   Y  
Peri-Op Glucose <200   Y   Y  
Peri-Op Transfusion II Y   Y  
Skin Prep I Y   Y  
Hair Removal II Y   Y  
Abx Irrigation   Y   Y  
Injections into Wound (e.g., Local Anesthetic)   Y   Y  
Implant   Y   Y  
Tissue expander use D        
Daily living assistance needed M        
Excessive blood loss; > 1 liter M        
Suture material (Deep, and in wound) D        
Incision method M        
Frequency of glove change U        
Subcutaneous hematoma D if ICD9 or M        
Hx of cancer D        
Periop allogeneic blood transfusion M for periop        
Interop vasopressor D        
preop mechanical ventilation LL        
Hx of abx allergy LL        
Preop urinary catheterization LL        
Skin closure method M        
Periop lapse in discipline? ??        
Transfer from another hospital D        
Tumor necrosis factor blockers D        
Development of DVT D        
Intraop inspired O2 < 50% M        
Duration of hypothermia; < 35.5 D for approx. time        
Tracheotomy D        
Bowel or bladder dysfunction D        
No. of surgeons scrubbed D        
Hx of COPD D        
Page last reviewed December 2012
Internet Citation: Appendix I. Initial Risk Factors. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ssi/ssiapi.html