Description

Neumayer et al developed a risk score for surgical site infection (SSI) based on data from the Patient Safety in Surgery Study and the National Surgical Quality Improvement Program (NSQIP). This can help identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in the United States and the Department of Veterans Affairs.


Parameters:

(1) type of operation

(2) relative value unit (RVU) for the operation

(3) type of wound

(4) ASA class

(5) timing for the operation

(6) diabetes

(7) smoking

(8) dyspnea

(9) steroid use

(10) serum albumin

(11) age

(12) total serum bilirubin

(13) radiotherapy for cancer within past 3 months (last 90 days)

(14) number of alcoholic drinks per day

 

Parameter

Finding

Points

type of operation

stomach or intestines

2

 

aneurysm or blood vessel repair

1

 

thoracoabdominal aneurysm

1

 

skin or musculoskeletal

2

 

respiratory

1

 

oral surgery; mouth or palate

0

 

hernia or endocrine

1

relative value units for operation

> 17

4

 

10 to 17

2

 

< 10

0

type of wound

contaminated or infected

2

 

clean/contaminated

1

 

clean

0

ASA class

1

0

 

2 to 5

2

time of operation

emergency

2

 

other

0

diabetes

absent

0

 

present

1

smoker

no

0

 

yes

1

dyspnea

absent

0

 

present

1

steroid use

no

0

 

yes

1

serum albumin

<= 3.5 g/dL

1

 

> 3.5 g/dL

0

age of the patient

< 40 years of age

0

 

>= 40 years of age

1

total serum bilirubin

<= 1 mg/dL

0

 

> 1 mg/dL

1

radiotherapy within last 3 months

no

0

 

yes

1

number of alcoholic drinks per day

<= 2

0

 

> 2

1

 

where:

• Stomach and intestinal surgery: codes 43500 to 49429; 49650 to 49999

• Aneurysm or blood vessel repair: codes 35001 to 37799

• Thoracoabdominal aneurysm repair: 33001 to 34900

• Skin or musculoskeletal: 10000 to 29999

• Respiratory: 30000 to 32999; 38000 to 39999

• Mouth or palate: 40000 to 43499

• Hernia or endocrine: 49491 to 49611; 60000 to 60999.

 

total index =

= SUM(points for all 14 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 21

• The higher the index the greater the risk for a surgical site infection.

 

Index

Percent with SSI

1 or 2

< 1%

3 or 4

1.0%

5 or 6

1.5 to 2%

7 or 8

3.0 to 4%

9

4.4%

10

6.6%

11

8.8%

12 or 13

10 to 11%

14 or 15

12.5%

16

15%

from Figure 1, page 1185


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