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| 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)
