American Journal of Epidemiology Vol. 121, No. 2: 206-215
Copyright © 1985 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
IDENTIFYING PATIENTS AT HIGH RISK OF SURGICAL WOUND INFECTION
A SIMPLE MULTIVARIATE INDEX OF PATIENT SUSCEPTIBILITY AND WOUND CONTAMINATION
1Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services Atlanta, GA
Address for reprints: SENIC Project, 
Public Inquiries Office, Centers for Disease Control, Atlanta, GA 30333
To predict the likelihood that a patient will develop a surgical wound infection from several risk factors, the authors used information collected on 58,498 patients undergoing operations in 1970 to develop a simple multivariate risk index. Analyzing 10 risk factors with stepwise multiple logistic regression tech niques, they developed a model combining information on four of the risk factors to predict a patient's probability of getting a surgical wound infection. Then, with information collected on another sample of 59,352 surgical patients admitted in 1975–1976, the validity of this index as a predictor of surgical wound infection risk was verified. With the simplified index, a subgroup, consisting of half the surgical patients, can be identified in whom 90% of the surgical wound infections will develop. By the inclusion of factors measuring therisk due to the patient's susceptibility as well as that due to the level of wound contamination, the simplified index predicts surgical wound infection risk about twice as well as the traditional classification of wound contamination (Goodman-Kruskal G=0.67 vs. 0.36, p<0.0001). Use of this new index might substantially increase the efficiency of routine surgical wound infection surveillance and control.
costs and cost analysis; cross infection; health services research; health surveys; sampling studies; surgical wound infection
2Current address:Division of Epidemiology and Preventive Medicine, Department of Internal Medicine, Southwestern Medical School, University of Texas Health Science Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX
3Current address: Department of Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, 6010 43rd Street, NE, Seattle, WA
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. S. Meyhoff, J. Wetterslev, L. N. Jorgensen, S. W. Henneberg, C. Hogdall, L. Lundvall, P.-E. Svendsen, H. Mollerup, T. H. Lunn, I. Simonsen, et al. Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery: The PROXI Randomized Clinical Trial JAMA, October 14, 2009; 302(14): 1543 - 1550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Qadan, O. Akca, S. S. Mahid, C. A. Hornung, and H. C. Polk Jr Perioperative Supplemental Oxygen Therapy and Surgical Site Infection: A Meta-analysis of Randomized Controlled Trials Arch Surg, April 1, 2009; 144(4): 359 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Fusconi, A. Gallo, C. Vitiello, G. Pagliuca, G. Pulice, and M. de Vincentiis Clean-Contaminated Neck Surgery: Risk of Infection by Intrinsic and Extrinsic Factors. Arch Otolaryngol Head Neck Surg, September 1, 2006; 132(9): 953 - 957. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Kabon, O. Akca, A. Taguchi, A. Nagele, R. Jebadurai, C. F. Arkilic, N. Sharma, A. Ahluwalia, S. Galandiuk, J. Fleshman, et al. Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection Anesth. Analg., November 1, 2005; 101(5): 1546 - 1553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Belda, L. Aguilera, J. Garcia de la Asuncion, J. Alberti, R. Vicente, L. Ferrandiz, R. Rodriguez, R. Company, D. I. Sessler, G. Aguilar, et al. Supplemental Perioperative Oxygen and the Risk of Surgical Wound Infection: A Randomized Controlled Trial JAMA, October 26, 2005; 294(16): 2035 - 2042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Nichols Preventing Surgical Site Infections Clin. Med. Res., May 1, 2004; 2(2): 115 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Treschan, A. Taguchi, S. Z. Ali, N. Sharma, B. Kabon, D. I. Sessler, and A. Kurz The Effects of Epidural and General Anesthesia on Tissue Oxygenation Anesth. Analg., June 1, 2003; 96(6): 1553 - 1557. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Pessaux, S. Msika, D. Atalla, J.-M. Hay, and Y. Flamant Risk Factors for Postoperative Infectious Complications in Noncolorectal Abdominal Surgery: A Multivariate Analysis Based on a Prospective Multicenter Study of 4718 Patients Arch Surg, March 1, 2003; 138(3): 314 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Zelenitsky, R. E. Ariano, G. K. M. Harding, and R. E. Silverman Antibiotic Pharmacodynamics in Surgical Prophylaxis: an Association between Intraoperative Antibiotic Concentrations and Efficacy Antimicrob. Agents Chemother., September 1, 2002; 46(9): 3026 - 3030. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. K. Harrison and M. Habil Optical Measurement of Tissue Oxygen Saturation International Journal of Lower Extremity Wounds, September 1, 2002; 1(3): 191 - 201. [Abstract] [PDF]
|
|
|
|
|
|
J. J. Parienti, P. Thibon, R. Heller, Y. Le Roux, P. von Theobald, H. Bensadoun, A. Bouvet, F. Lemarchand, X. Le Coutour, and for Members of the Antisepsie Chirurgicale des Mai Hand-Rubbing With an Aqueous Alcoholic Solution vs Traditional Surgical Hand-Scrubbing and 30-Day Surgical Site Infection Rates: A Randomized Equivalence Study JAMA, August 14, 2002; 288(6): 722 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Delgado-Rodriguez, M. Medina-Cuadros, A. Gomez-Ortega, G. Martinez-Gallego, M. Mariscal-Ortiz, M. A. Martinez-Gonzalez, and M. Sillero-Arenas Cholesterol and Serum Albumin Levels as Predictors of Cross Infection, Death, and Length of Hospital Stay Arch Surg, July 1, 2002; 137(7): 805 - 812. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. F Kapasi, P. A Catlin, J. Beck, T. Roehling, and K. Smith The Role of Endogenous Opioids in Moderate Exercise Training-Induced Enhancement of the Secondary Antibody Response in Mice Physical Therapy, November 1, 2001; 81(11): 1801 - 1809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Jin and F. Chung Minimizing perioperative adverse events in the elderly{dagger} Br. J. Anaesth., October 1, 2001; 87(4): 608 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Plattner, O. Akca, F. Herbst, C. F. Arkilic, R. Fugger, M. Barlan, A. Kurz, H. Hopf, A. Werba, and D. I. Sessler The Influence of 2 Surgical Bandage Systems on Wound Tissue Oxygen Tension Arch Surg, July 1, 2000; 135(7): 818 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Greif, O. Akca, E.-P. Horn, A. Kurz, D. I. Sessler, and The Outcomes Research Group Supplemental Perioperative Oxygen to Reduce the Incidence of Surgical-Wound Infection N. Engl. J. Med., January 20, 2000; 342(3): 161 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gottrup Prevention of Surgical-Wound Infections N. Engl. J. Med., January 20, 2000; 342(3): 202 - 204. [Full Text]
|
|
|
|
|
|
D. B. Allen, J. J. Maguire, M. Mahdavian, C. Wicke, L. Marcocci, H. Scheuenstuhl, M. Chang, A. X. Le, H. W. Hopf, and T. K. Hunt Wound Hypoxia and Acidosis Limit Neutrophil Bacterial Killing Mechanisms Arch Surg, September 1, 1997; 132(9): 991 - 996. [Abstract] [PDF]
|
|
|
|
|
|
H. W. Hopf, T. K. Hunt, J. M. West, P. Blomquist, W. H. Goodson III, J. A. Jensen, K. Jonsson, P. B. Paty, J. M. Rabkin, R. A. Upton, et al. Wound Tissue Oxygen Tension Predicts the Risk of Wound Infection in Surgical Patients Arch Surg, September 1, 1997; 132(9): 997 - 1004. [Abstract] [PDF]
|
|
|
|
|
|
A. Kurz, D. I. Sessler, R. Lenhardt, The Study of Wound Infection and, and Temperature Group Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization N. Engl. J. Med., May 9, 1996; 334(19): 1209 - 1216. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. PLATT and R. E. PAGE Post-Operative Infection Following Hand Surgery: Guidelines for Antibiotic Use J Hand Surg Eur Vol., October 1, 1995; 20(5): 685 - 690. [Abstract] [PDF]
|
|
|
|
|
|
R. L. Nichols and J. W. Smith Bacterial Contamination of an Anesthetic Agent N. Engl. J. Med., July 20, 1995; 333(3): 184 - 185. [Full Text]
|
|
|
|
|
|
T. J. Babineau, A. Hackford, A. Kenler, B. Bistrian, R. A. Forse, P. G. Fairchild, S. Heard, M. Keroack, P. Caushaj, and P. Benotti A Phase II Multicenter, Double-blind, Randomized, Placebo-Controlled Study of Three Dosages of an Immunomodulator (PGG-Glucan) in High-Risk Surgical Patients Arch Surg, November 1, 1994; 129(11): 1204 - 1210. [Abstract] [PDF]
|
|
|
|
|
|
R. L. Nichols, J. W. Smith, G. D. Robertson, A. C. Muzik, P. Pearce, V. Ozmen, N. E. McSwain Jr, and L. M. Flint Prospective Alterations in Therapy for Penetrating Abdominal Trauma Arch Surg, January 1, 1993; 128(1): 55 - 64. [Abstract] [PDF]
|
|
|
|
|
|
C. P. Page, J. M. A. Bohnen, J. R. Fletcher, A. T. McManus, J. S. Solomkin, and D. H. Wittmann Antimicrobial Prophylaxis for Surgical Wounds: Guidelines for Clinical Care Arch Surg, January 1, 1993; 128(1): 79 - 88. [Abstract] [PDF]
|
|
|
|
 |
|
 S. J. Sokalski, M. A. Jewell, A. C. Asmus-Shillington, J. Mulcahy, and J. Segreti An Outbreak of Serratia marcescens in 14 Adult Cardiac Surgical Patients Associated With 12-Lead Electrocardiogram Bulbs Arch Intern Med, April 1, 1992; 152(4): 841 - 844. [Abstract] [PDF]
|
|
|
|
|
|
M. M. Olson and J. T. Lee Jr Continuous, 10-Year Wound Infection Surveillance: Results, Advantages, and Unanswered Questions Arch Surg, June 1, 1990; 125(6): 794 - 803. [Abstract] [PDF]
|
|
|
|
|
|
D. R. Knighton, V. D. Fiegel, T. Halverson, S. Schneider, T. Brown, and C. L. Wells Oxygen as an Antibiotic: The Effect of Inspired Oxygen on Bacterial Clearance Arch Surg, January 1, 1990; 125(1): 97 - 100. [Abstract] [PDF]
|
|
|
|
|
|
D. Franco, C. Smadja, J. L. Meakins, A. Wu, L. Berthoux, and D. Grange Improved Early Results of Elective Hepatic Resection for Liver Tumors: One Hundred Consecutive Hepatectomies in Cirrhotic and Noncirrhotic Patients Arch Surg, September 1, 1989; 124(9): 1033 - 1037. [Abstract] [PDF]
|
|
|
|
 |
|
 J. A. Hanley The Robustness of the "Binormal" Assumptions Used in Fitting ROC Curves Med Decis Making, August 1, 1988; 8(3): 197 - 203. [Abstract] [PDF]
|
|
|
|
|
|
R. E. Condon, R. W. Haley, J. T. Lee Jr, and J. L. Meakins Does Infection Control Control Infection? Arch Surg, February 1, 1988; 123(2): 250 - 256. [Abstract] [PDF]
|
|
|
|
|
|
N. V. Christou, C. W. Nohr, and J. L. Meakins Assessing Operative Site Infection in Surgical Patients Arch Surg, February 1, 1987; 122(2): 165 - 169. [Abstract] [PDF]
|
|