Risk Scores of Terracciano et al for Postoperative Infections

NOTE: The material has been translated from the Italian and may have suffered in the process.

Patients studied: 1,182 who underwent surgery (28 developed sepsis, 119 infection and 93 surgical wound infections)

Variables:

(1) bacterial contamination during surgery

(2) duration of surgery

(3) "colostasi" (see below)

(4) hypoalbuminemia

where:

• I could not find the value for serum albumin used by the authors to define hypoalbuminemia. Possible choices might be 3.2, 3.0, 2.8 or 2.5 g/dL. I use < 3.0 g/dL in the implementation.

• "Colostasi" was hard to translate from the Italian. According to the scholar Dr H. Germanuik, it could mean either cholestasis or bowel obstruction, depending on context. In light of the use of "incomplete" and "complete" (see below), I take it to mean bowel obstruction.

Endpoints:

(1) sepsis

(2) infection (includes UTI, bronchopneumonia, etc.)

(3) surgical wound infection with suppuration, with or without wound dehiscence

risk score for sepsis =

= (points for bacterial contamination) + (points for duration) + (points for bowel obstruction)

risk score for infection =

= (points for bacterial contamination) + (points for duration) + (points for hypoalbuminemia)

risk score for surgical wound infection with or without dehiscence =

= (points for bacterial contamination) + (points for duration) + (points for hypoalbuminemia)

Interpretation:

• minimum score (all 3): 0

• maximum sepsis score: 5.0

• maximum infection score: 3.0

• maximum surgical wound infection score: 2.5

• The higher the score, the greater the risk for the particular infectious complication.

Limitations:

• The probability could be impacted by additional variables (preoperative antibiotics, intraoperative antibiotics, surgical skill, immune compromise, etc.), so the probability will differ between institutions.

• The patient diagnosis and operation mix would affect the prevalence of infection. My guess is that the patients were general surgical patients with mostly intra-abdominal procedures. This is based on the emphasis on bacterial contamination and bowel obstruction.