ssiapm.htm Appendix M. Master Risk Factor List with Final Bolded Factor included in the final list of risk factors are boldedDiagnoses and conditions are defined by ICD-9 codes Risk FactorEvidenceMod?Pat.PeriopSurg.EMRDefineIHDenver DSS, MANUAL FROM EDM, ICP, UNAVAILABLEVail DSS, MANUAL FROM EDM, ICP, UNAVAILABLEPRESENT AT SLC VACommon w/ VACommon ElementsAge NY 1 Y = EMRD = EMRElectronic = EMR1YYGender NY 1 YDElectronic1YYBody Mass IndexIINY 1 YLL = found in LifeLink onlyElectronicNSQIPNSQIPYComorbidity Score (Charlson or whatever is available) NY 1 Y????1 DiabetesIINY 1 YDElectronic1YYChronic Lung Disease NY 1depends on definitionDElectronic1YYChronic Kidney Disease NY 1depends on definitionDElectronic1YYPeripheral vascular disease NY 1depends on definitionDElectronic1 YPrior site irradiation (At any time) NY 1YMManualNSQIP - w/in 90d Recent operation (Within 30 days) NY Time window?YDManual1 Skin carriage of staphylococci NY 1chart reviewD if in microElectronic (if done in our lab)1 Skin disease in the area of surgery (eg, psoriasis) NY ? chart reviewMManualSkin dis, but not localization Wound ClassINY 1 YDElectronic1YYEmergent Procedure NY 1 YDElectronicNSQIPNSQIPYASA ScoreINY 1 at 3 hospitalsMElectronic1 Revision/Re-do Operation NY 1ICD-9 codes, laterality unknownD is use ORSOS codesElectronic1 Pre-Op Hospitalization (# of days) NY Time window?surgery start time - admission timeDElectronic1YYHx of MRSA NY 1< 5 years?YDElectronic1YYHomelessness NY ? NDManual0 Hospitalizations in Prior 12 Months (#) NY 1 system hospitalizations onlyDManual (if at VVMC or mentioned in H&P)1 Surgical Site NY 1 laterality unknownDICP1 Insurance/Payor Source NY 11YDElectroniccheck with Pat YHx Rheumatologic Disease NY 1YDElectronic1YYPrevious Surgical Site Infection NY 1 just last year for most hospitalsDICP1 Instututionalized NY 1system institutionalizations onlyDManual (if in H&P)? NNIS Risk IndexINY 1don't knowI ??ICP1 Glucose Control (Hgb A1C and Pre-op Glucose) YY 1YDNot sure what you're looking for1 Hypocholesterolemia YY 1YDElectronic1YYPreoperative anemia (recorded as hemoglobin level) YY 1have times of surgery and times of HCTDElectronic1YYPostoperative anemia (recorded as hemoglobin level) YY 1have times of surgery and times of HCTDElectronic1YYRemote infection YY 1define???ICP1 Malnutrition (Wt loss, albumin, prealbumin) YY 1N??If albumin is drawn - Electronicalbumin, etc Smoking YY 1 some positivesLLElectronicw/in 1 year in NSQIP Alcohol Abuse YY 1some positivesDElectronicNSQIPNSQIPYSubstance Abuse YY 1some positivesDElectronic0 YStaph Aureus Colonization YY 1 what Scott says??Electronic (if done in our lab)1 Preoperative Shower YY ? chart review??Electronic? Immunosuppressive Drugs Pre-Op YY 1Need med listchart reviewMManual1 Pre-Op Albumin Level Y 11time of surgery and time of blood drawDElectronic1YYAscites Y 1abdominalM or LLManualNSQIP - w/in 30d Chronic inflammation Y 1define?M or DManualif CRP, ESR then yes Corticosteroid therapy w/in 30 Days Y 1need med listif in systemM or DManual1 Duration of Surgery (min) N Y 1 YDElectronic1 YTourniquet Time N Y ? don't knowM ??Manual0 Post-Op Mechanical Ventilation N Y 1 chart reviewDManualNSQIP for >48h Surgeon Experience (# Past 12 Months) N Y1DefineYDElectronic1YYSurgeon Age N Y? YDManual0 Laparoscopic ApproachIY Y 1 chart review prior to Oct 2008DElectronicif indicated by code General Anesthesia Y Y 1 intra-op drugs on paper anesthesia recordDElectronic1YYNo. of Personnel in OR Y Y ? YDManual1 Trainee (Lowest Level) Scrubbed in OR Y Y ? YD (can u tell who is scrubbed in ORSOS)Manual1 OR Traffic Y Y ? NUUnavailable0 Timely Pre-Op AbxIY Y ? chart reviewD (or M if core measures criteria)Electronic1 Appropriate Pre-op AbxIIY Y 1chart reviewD (or M if core measures criteria)Electronic1 Discontinuation of Post-Op Abx <24 hrIIIY Y 1 YD (or M if core measures criteria)Electronic1YYAppropriate Intra-Op Re-dosing of Abx Y Y no on paper anesthesia recordD (or M if core measures criteria)Manual1 Lowest Intra-Op TemperatureIY Y ? on paper anesthesia recordMManualnot reliably Temperature on Arrival to PACUIY Y ? on paper anesthesia recordMElectronicnot reliably Peri-Op Glucose <100 Y Y 1 YMElectronic1 Peri-Op Glucose <200 Y Y 1 YMElectronic1 Peri-Op TransfusionIIY Y 1 times on paper for intra-op transfusionsMElectronic1 Skin PrepIY Y ? chart auditMElectronic0 Hair RemovalIIY Y ? chart auditMElectronic0 Abx Irrigation Y Y ? chart auditDElectronic0 Injections into Wound (e.g., Local Anesthetic) Y Y ? chart auditDElectronic0 Implant Y Y 1 YDElectronic1 Anesthetic Drugs Y Y ? intra-op drugs on paper anesthesia recordDManual0 Outpatient Surgery Y Y 1 YDElectronic1YYInpatient Surgery Y Y 1 YDElectronic1YYPost-Op Admit Y Y 1time windowYDElectronic1YYLaminar Airflow OR Y Y 1 facility assessmentDAll VVMC ORs are laminar??YHEPA Filtered OR Y Y ? facility assessmentDAll VVMC ORs are laminar??YNumber of Procedures (in same OR session) Y Y 1 YDElectronic1YYUse of Drain Y Y ? YDElectronic??YICU Admission Post-Op Y Y 1 YDElectronic1YYPerioperative Hyperoxia (FiO2 80%) Y Y 1 don't knowLLManual1 Peri-Op Insulin Administration Y Y 1intra-op drugs on paper anesthesia recordDElectronic for pre-op/PACU, manual for OR1 Peri-Op Proton Pump Inhibitor Y Y 1intra-op drugs on paper anesthesia recordDElectronic1 Peri-Op VTE Prophylaxis Y Y 1 intra-op drugs on paper anesthesia recordDElectronic1 Post-Op Wound Care by Nurse Y Y 1 chart reviewLLManual? Anticoagulation Medication Y Y 1 intra-op drugs on paper anesthesia recordDElectronic1 Post-Op Ambulation (What Day?) Y Y 1 not reliable retrospectivelyLLElectronic? Liters of IV Fluid in OR Y Y ? on paper anesthesia recordMElectronic? Liters of Fluid 24 hrs Post-Op Y Y 1 YMElectronic1 Central Line Y Y 1 YD or M??Electronic0 YPre-Op Hemoglobin (post-op was later added) Y 1 YDElectronic1YYUse of Stryker Suit Y Y? Y??Manual? Surgeon Beard Y Y? self-report??Manual0 New/possible added by Scott Tissue expander use ? YDElectronic??YDaily living assistance needed ? NMManual/?? Electronic? Excessive blood loss; > 1 liter ? OR chart reviewMManual1 Suture material (Deep, and in wound) ? OR chart reviewDElectronic? Incision method ? OR chart reviewMManual0 Frequency of glove change ? NUUnavailable0 Subcutaneous hematoma ? can't identify subcutaneousD if ICD9 or MManual0 Hx of cancer 1 YDElectronic1YYPeriop allogeneic blood transfusion 1 OR chart review, allogenic status iffyM for periopElectronic1 Interop vasopressor ? paper anesthesia recordDManual1 Preop mechanical ventilation 1 chart auditLLElectronic? Hx of abx allergy 1 YLLElectronicI think so?YPreop urinary catheterization 1 chart reviewLLElectronic0 Skin closure method ? OR record chart reviewMManual0 Periop lapse in discipline? ? define???Unavailable/maybe in H&P0 Transfer from another hospital 1 YDManual1 Tumor necrosis factor blockers 1 NDElectronic1 Development of DVT 1 YDElectronic1YYIntraop inspired O2 < 50% ? paper anesthesia recordMManual0 Duration of hypothermia; < 35.5 ? paper anesthesia recordD for approx. timeManual0 Tracheotomy 1 YDElectronic/?? Manual1 Bowel or bladder dysfunction ? define?DElectronic??YNo. of surgeons scrubbed ? YDElectronic??YHx of COPD ? YDElectronic1YYTotal 44 254036 risk factors in the final list 11 ? or NSQIP Note: The following factors were included in the final list of risk factors for identification and stratification purposes.Source of AdmissionPatient ID (random number with system prefix identifierSSI as a result of this surgerySurgery date/timeSurgical Procedure (TH, TK, CA, HE)Return to Contents Proceed to Next Section Current as of December 2012 Internet Citation: ssiapm.htm. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ssi/ssiapm.html
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