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

Appendix M. Master Risk Factor List with Final Bolded

  • Factor included in the final list of risk factors are bolded
  • Diagnoses and conditions are defined by ICD-9 codes

 

Risk Factor Evidence Mod? Pat. Periop Surg. EMR Define IH Denver DSS, MANUAL FROM EDM, ICP, UNAVAILABLE Vail DSS, MANUAL FROM EDM, ICP, UNAVAILABLE PRESENT AT SLC VA Common w/ VA Common Elements
Age   N Y     1   Y = EMR D = EMR Electronic = EMR 1 Y Y
Gender   N Y     1   Y D Electronic 1 Y Y
Body Mass Index II N Y     1   Y LL = found in LifeLink only Electronic NSQIP NSQIP Y
Comorbidity Score (Charlson or whatever is available)   N Y     1   Y ?? ?? 1    
Diabetes II N Y     1   Y D Electronic 1 Y Y
Chronic Lung Disease   N Y       1 depends on definition D Electronic 1 Y Y
Chronic Kidney Disease   N Y       1 depends on definition D Electronic 1 Y Y
Peripheral vascular disease   N Y       1 depends on definition D Electronic 1   Y
Prior site irradiation (At any time)   N Y       1 Y M Manual NSQIP - w/in 90d    
Recent operation (Within 30 days)   N Y       Time window? Y D Manual 1    
Skin carriage of staphylococci   N Y       1 chart review D if in micro Electronic (if done in our lab) 1    
Skin disease in the area of surgery (eg, psoriasis)   N Y     ?   chart review M Manual Skin dis, but not localization    
Wound Class I N Y     1   Y D Electronic 1 Y Y
Emergent Procedure   N Y     1   Y D Electronic NSQIP NSQIP Y
ASA Score I N Y     1   at 3 hospitals M Electronic 1    
Revision/Re-do Operation   N Y       1 ICD-9 codes, laterality unknown D is use ORSOS codes Electronic 1    
Pre-Op Hospitalization (# of days)   N Y       Time window? surgery start time - admission time D Electronic 1 Y Y
Hx of MRSA   N Y     1 < 5 years? Y D Electronic 1 Y Y
Homelessness   N Y     ?   N D Manual 0    
Hospitalizations in Prior 12 Months (#)   N Y     1   system hospitalizations only D Manual (if at VVMC or mentioned in H&P) 1    
Surgical Site   N Y     1   laterality unknown D ICP 1    
Insurance/Payor Source   N Y     1 1 Y D Electronic check with Pat   Y
Hx Rheumatologic Disease   N Y       1 Y D Electronic 1 Y Y
Previous Surgical Site Infection   N Y     1   just last year for most hospitals D ICP 1    
Instututionalized   N Y       1 system institutionalizations only D Manual (if in H&P) ?    
NNIS Risk Index I N Y       1 don't know I ?? ICP 1    
Glucose Control (Hgb A1C and Pre-op Glucose)   Y Y       1 Y D Not sure what you're looking for 1    
Hypocholesterolemia   Y Y       1 Y D Electronic 1 Y Y
Preoperative anemia (recorded as hemoglobin level)   Y Y       1 have times of surgery and times of HCT D Electronic 1 Y Y
Postoperative anemia (recorded as hemoglobin level)   Y Y       1 have times of surgery and times of HCT D Electronic 1 Y Y
Remote infection   Y Y       1 define? ?? ICP 1    
Malnutrition (Wt loss, albumin, prealbumin)   Y Y       1 N ?? If albumin is drawn - Electronic albumin, etc    
Smoking   Y Y     1   some positives LL Electronic w/in 1 year in NSQIP    
Alcohol Abuse   Y Y       1 some positives D Electronic NSQIP NSQIP Y
Substance Abuse   Y Y       1 some positives D Electronic 0   Y
Staph Aureus Colonization   Y Y     1   what Scott says ?? Electronic (if done in our lab) 1    
Preoperative Shower   Y Y     ?   chart review ?? Electronic ?    
Immunosuppressive Drugs Pre-Op   Y Y     1 Need med list chart review M Manual 1    
Pre-Op Albumin Level     Y     1 1 time of surgery and time of blood draw D Electronic 1 Y Y
Ascites     Y       1 abdominal M or LL Manual NSQIP - w/in 30d    
Chronic inflammation     Y       1 define? M or D Manual if CRP, ESR then yes    
Corticosteroid therapy  w/in 30 Days     Y     1 need med list if in system M or D Manual 1    
Duration of Surgery (min)   N   Y   1   Y D Electronic 1   Y
Tourniquet Time   N   Y   ?   don't know M ?? Manual 0    
Post-Op Mechanical Ventilation   N   Y   1   chart review D Manual NSQIP for >48h    
Surgeon Experience (# Past 12 Months)   N     Y 1 Define Y D Electronic 1 Y Y
Surgeon Age   N     Y ?   Y D Manual 0    
Laparoscopic Approach I Y   Y   1   chart review prior to Oct 2008 D Electronic if indicated by code    
General Anesthesia   Y   Y   1   intra-op drugs on paper anesthesia record D Electronic 1 Y Y
No. of Personnel in OR   Y   Y   ?   Y D Manual 1    
Trainee (Lowest Level) Scrubbed in OR   Y   Y   ?   Y D (can u tell who is scrubbed in ORSOS) Manual 1    
OR Traffic   Y   Y   ?   N U Unavailable 0    
Timely Pre-Op Abx I Y   Y   ?   chart review D (or M if core measures criteria) Electronic 1    
Appropriate Pre-op Abx II Y   Y     1 chart review D (or M if core measures criteria) Electronic 1    
Discontinuation of Post-Op Abx <24 hr III Y   Y   1   Y D (or M if core measures criteria) Electronic 1 Y Y
Appropriate Intra-Op Re-dosing of Abx   Y   Y   no   on paper anesthesia record D (or M if core measures criteria) Manual 1    
Lowest Intra-Op Temperature I Y   Y   ?   on paper anesthesia record M Manual not reliably    
Temperature on Arrival to PACU I Y   Y   ?   on paper anesthesia record M Electronic not reliably    
Peri-Op Glucose <100   Y   Y   1   Y M Electronic 1    
Peri-Op Glucose <200   Y   Y   1   Y M Electronic 1    
Peri-Op Transfusion II Y   Y   1   times on paper for intra-op transfusions M Electronic 1    
Skin Prep I Y   Y   ?   chart audit M Electronic 0    
Hair Removal II Y   Y   ?   chart audit M Electronic 0    
Abx Irrigation   Y   Y   ?   chart audit D Electronic 0    
Injections into Wound (e.g., Local Anesthetic)   Y   Y   ?   chart audit D Electronic 0    
Implant   Y   Y   1   Y D Electronic 1    
Anesthetic Drugs   Y   Y   ?   intra-op drugs on paper anesthesia record D Manual 0    
Outpatient Surgery   Y   Y   1   Y D Electronic 1 Y Y
Inpatient Surgery   Y   Y   1   Y D Electronic 1 Y Y
Post-Op Admit   Y   Y   1 time window Y D Electronic 1 Y Y
Laminar Airflow OR   Y   Y   1   facility assessment D All VVMC ORs are laminar ? ? Y
HEPA Filtered OR   Y   Y   ?   facility assessment D All VVMC ORs are laminar ? ? Y
Number of Procedures (in same OR session)   Y   Y   1   Y D Electronic 1 Y Y
Use of Drain   Y   Y   ?   Y D Electronic ? ? Y
ICU Admission Post-Op   Y   Y   1   Y D Electronic 1 Y Y
Perioperative Hyperoxia (FiO2 80%)   Y   Y   1   don't know LL Manual 1    
Peri-Op Insulin Administration   Y   Y     1 intra-op drugs on paper anesthesia record D Electronic for pre-op/PACU, manual for OR 1    
Peri-Op Proton Pump Inhibitor   Y   Y     1 intra-op drugs on paper anesthesia record D Electronic 1    
Peri-Op VTE Prophylaxis   Y   Y   1   intra-op drugs on paper anesthesia record D Electronic 1    
Post-Op Wound Care by Nurse   Y   Y   1   chart review LL Manual ?    
Anticoagulation Medication   Y   Y   1   intra-op drugs on paper anesthesia record D Electronic 1    
Post-Op Ambulation (What Day?)   Y   Y   1   not reliable retrospectively LL Electronic ?    
Liters of IV Fluid in OR   Y   Y   ?   on paper anesthesia record M Electronic ?    
Liters of Fluid 24 hrs Post-Op   Y   Y   1   Y M Electronic 1    
Central Line   Y   Y   1   Y D or M?? Electronic 0   Y
Pre-Op Hemoglobin (post-op was later added)   Y       1   Y D Electronic 1 Y Y
Use of Stryker Suit   Y     Y ?   Y ?? Manual ?    
Surgeon Beard   Y     Y ?   self-report ?? Manual 0    
New/possible added by Scott                          
Tissue expander use           ?   Y D Electronic ? ? Y
Daily living assistance needed           ?   N M Manual/?? Electronic ?    
Excessive blood loss; > 1 liter           ?   OR chart review M Manual 1    
Suture material (Deep, and in wound)           ?   OR chart review D Electronic ?    
Incision method           ?   OR chart review M Manual 0    
Frequency of glove change           ?   N U Unavailable 0    
Subcutaneous hematoma           ?   can't identify subcutaneous D if ICD9 or M Manual 0    
Hx of cancer           1   Y D Electronic 1 Y Y
Periop allogeneic blood transfusion           1   OR chart review, allogenic status iffy M for periop Electronic 1    
Interop vasopressor           ?   paper anesthesia record D Manual 1    
Preop mechanical ventilation           1   chart audit LL Electronic ?    
Hx of abx allergy           1   Y LL Electronic I think so ? Y
Preop urinary catheterization           1   chart review LL Electronic 0    
Skin closure method           ?   OR record chart review M Manual 0    
Periop lapse in discipline?           ?   define? ?? Unavailable/maybe in H&P 0    
Transfer from another hospital           1   Y D Manual 1    
Tumor necrosis factor blockers           1   N D Electronic 1    
Development of DVT           1   Y D Electronic 1 Y Y
Intraop inspired O2 < 50%           ?   paper anesthesia record M Manual 0    
Duration of hypothermia; < 35.5           ?   paper anesthesia record D for approx. time Manual 0    
Tracheotomy           1   Y D Electronic/?? Manual 1    
Bowel or bladder dysfunction           ?   define? D Electronic ? ? Y
No. of surgeons scrubbed           ?   Y D Electronic ? ? Y
Hx of COPD           ?   Y D Electronic 1 Y Y
Total               44       25 40
36 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 Admission
  • Patient ID (random number with system prefix identifier
  • SSI as a result of this surgery
  • Surgery date/time
  • Surgical Procedure (TH, TK, CA, HE)
Page last reviewed December 2012
Internet Citation: Appendix M. Master Risk Factor List with Final Bolded. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ssi/ssiapm.html