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

Appendix K. Final Risk Factors

Risk Factor Important Feasible Feasible, Difficult
(e.g. Chart Review)
Age 6 6 0
Gender 3 5 0
Body Mass Index 6 4 1
Comorbidity Score (Charlson or whatever is available) 5 2 1
Diabetes 6 3 1
Chronic Lung Disease 3 2 1
Chronic Kidney Disease 3 2 1
Peripheral vascular disease 2 1 1
Prior site irradiation (At any time) 3 1 2
Recent operation (Within 30 days) 5 4 0
Skin carriage of staphylococci 3 1 1
Skin disease in the area of surgery (eg, psoriasis) 2 0 1
Wound Class 6 5 1
Emergent Procedure 5 5 0
ASA Score 5 5 0
Revision/Re-do Operation 4 4 0
Pre-Op Hospitalization (# of days) 5 5 0
Hx of MRSA 3 2 1
Homelessness 1 0 0
Hospitalizations in Prior 12 Months (#) 0 0 0
Surgical Site 3 5 0
Insurance/Payor Source 0 1 0
Hx Rheumatologic Disease 1 2 0
Previous Surgical Site Infection 5 4 1
Instututionalized 2 2 0
NNIS Risk Index 4 1 1
Glucose Control (Hgb A1C and Pre-op Glucose) 6 5 0
Hypocholesterolemia 0 1 0
Preoperative anemia 6 6 0
Postoperative anemia 3 4 0
Remote infection 4 3 1
Malnutrition (Wt loss, albumin, prealbumin) 6 4 1
Smoking 6 6 0
Alcohol Abuse 4 5 0
Substance Abuse 1 2 0
Staph Aureus Colonization 3 2 0
Preoperative Shower 4 3 0
Immunosuppressive Drugs Pre-Op 5 5 0
Pre-Op Albumin Level 6 5 0
Ascites 5 2 1
Chronic inflammation 2 1 1
Corticosteroid therapy  w/in 30 Days 4 3 0
Duration of Surgery (min) 6 5 0
Tourniquet Time 2 2 0
Post-Op Mechanical Ventilation 2 2 0
Surgeon Experience (# Past 12 Months) 3 2 0
Surgeon Age 0 0 0
Laparoscopic Approach 5 5 0
General Anesthesia 1 2 0
No. of Personnel in OR 3 2 0
Trainee (Lowest Level) Scrubbed in OR 2 2 0
OR Traffic 1 1 0
Timely Pre-Op Abx 6 6 0
Appropriate Pre-op Abx 6 6 0
Discontinuation of Post-Op Abx <24 hr 4 4 0
Appropriate Intra-Op Re-dosing of Abx 5 5 0
Lowest Intra-Op Temperature 5 5 0
Temperature on Arrival to PACU 5 5 0
Peri-Op Glucose <100 0 0 0
Peri-Op Glucose <200 6 4 1
Peri-Op Transfusion 5 4 1
Skin Prep 5 5 0
Hair Removal 5 5 0
Abx Irrigation 1 2 0
Injections into Wound (e.g., Local Anesthetic) 0 1 0
Implant 3 3 0
Anesthetic Drugs 0 0 0
Outpatient Surgery 2 2 0
Inpatient Surgery 2 2 0
Post-Op Admit 1 1 0
Laminar Airflow OR 1 1 0
HEPA Filtered OR 1 1 0
Number of Procedures (in same OR session) 1 1 0
Use of Drain 6 5 0
ICU Admission Post-Op 1 1 0
Perioperative Hyperoxia (FiO2 80%) 3 3 0
Peri-Op Insulin Administration 2 2 0
Peri-Op Proton Pump Inhibitor 1 1 0
Peri-Op VTE Prophylaxis 2 2 0
Post-Op Wound Care by Nurse 2 2 0
Anticoagulation Medication 2 2 0
Post-Op Ambulation (What Day?) 1 1 0
Liters of IV Fluid in OR 4 4 0
Liters of Fluid 24 hrs Post-Op 2 2 0
Central Line 2 3 0
Pre-Op Hemoglobobin 5 5 0
Use of Stryker Suit 0 1 0
Surgeon Beard 0 1 0
Tissue expander use 0 0 0
Daily living assistance needed 2 1 0
Excessive blood loss; > 1 liter 4 3 0
Suture material (Deep, and in wound) 4 3 0
Incision method 1 1 0
Frequency of glove change 1 0 0
Subcutaneous hematoma 4 2 0
Hx of cancer 2 2 0
Periop allogeneic blood transfusion 3 3 0
Interop vasopressor 3 3 0
preop mechanical ventilation 1 1 0
Hx of abx allergy 1 2 0
Preop urinary catheterization 2 3 0
Skin closure method 3 3 0
Periop lapse in discipline? 3 1 1
Transfer from another hospital 0 1 0
Tumor necrosis factor blockers 0 1 0
Development of DVT 0 1 0
Intraop inspired O2 < 50% 1 2 0
Duration of hypothermia; < 35.5 4 1 1
Tracheotomy 0 1 0
Bowel or bladder dysfunction 0 0 1
No. of surgeons scrubbed 1 2 0
Hx of COPD 1 2 0
Page last reviewed December 2012
Page originally created December 2012
Internet Citation: Appendix K. Final Risk Factors. Content last reviewed December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ssi/ssiapk.html