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 FactorEvidenceMod?Pat.PeriopSurg.EMRDefineIHDenver DSS, MANUAL FROM EDM, ICP, UNAVAILABLEVail DSS, MANUAL FROM EDM, ICP, UNAVAILABLEPRESENT AT SLC VACommon w/ VACommon Elements
Age NY  1 Y = EMRD = EMRElectronic = EMR1YY
Gender NY  1 YDElectronic1YY
Body Mass IndexIINY  1 YLL = found in LifeLink onlyElectronicNSQIPNSQIPY
Comorbidity Score (Charlson or whatever is available) NY  1 Y????1  
DiabetesIINY  1 YDElectronic1YY
Chronic Lung Disease NY   1depends on definitionDElectronic1YY
Chronic Kidney Disease NY   1depends on definitionDElectronic1YY
Peripheral vascular disease NY   1depends on definitionDElectronic1 Y
Prior 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 YDElectronic1YY
Emergent Procedure NY  1 YDElectronicNSQIPNSQIPY
ASA 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 timeDElectronic1YY
Hx of MRSA NY  1< 5 years?YDElectronic1YY
Homelessness 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 Y
Hx Rheumatologic Disease NY   1YDElectronic1YY
Previous 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   1YDElectronic1YY
Preoperative anemia (recorded as hemoglobin level) YY   1have times of surgery and times of HCTDElectronic1YY
Postoperative anemia (recorded as hemoglobin level) YY   1have times of surgery and times of HCTDElectronic1YY
Remote 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 positivesDElectronicNSQIPNSQIPY
Substance Abuse YY   1some positivesDElectronic0 Y
Staph 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 drawDElectronic1YY
Ascites  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 Y
Tourniquet Time N Y ? don't knowM ??Manual0  
Post-Op Mechanical Ventilation N Y 1 chart reviewDManualNSQIP for >48h  
Surgeon Experience (# Past 12 Months) N  Y1DefineYDElectronic1YY
Surgeon 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 recordDElectronic1YY
No. 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)Electronic1YY
Appropriate 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 YDElectronic1YY
Inpatient Surgery Y Y 1 YDElectronic1YY
Post-Op Admit Y Y 1time windowYDElectronic1YY
Laminar Airflow OR Y Y 1 facility assessmentDAll VVMC ORs are laminar??Y
HEPA Filtered OR Y Y ? facility assessmentDAll VVMC ORs are laminar??Y
Number of Procedures (in same OR session) Y Y 1 YDElectronic1YY
Use of Drain Y Y ? YDElectronic??Y
ICU Admission Post-Op Y Y 1 YDElectronic1YY
Perioperative 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 Y
Pre-Op Hemoglobin (post-op was later added) Y   1 YDElectronic1YY
Use of Stryker Suit Y  Y? Y??Manual?  
Surgeon Beard Y  Y? self-report??Manual0  
New/possible added by Scott             
Tissue expander use     ? YDElectronic??Y
Daily 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 YDElectronic1YY
Periop 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?Y
Preop 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 YDElectronic1YY
Intraop 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??Y
No. of surgeons scrubbed     ? YDElectronic??Y
Hx of COPD     ? YDElectronic1YY
Total       44   2540
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