Campos-Lobato et al developed a nomogram for predicting organ space surgical site infection (SSI) following small or large intestine surgery. The authors are from the Cleveland Clinic and the Johns Hopkins Hospital.
Patient selection: intestinal surgery
Outcome: organ space SSI
Parameters:
(1) surgical site
(2) smoker
(3) ASA class
(4) wound class
(5) diabetes
(6) steroid therapy in the past 30 days
(7) prior surgery in the past 30 days
(8) radiotherapy for cancer in the past 90 days
(9) surgical technique
(10) age of the patient in years, from 15 to 90
(11) body mass index (BMI) from 15 to 50
(12) serum creatinine in mg/dL from 0 to 6
(13) serum albumin in g/dL from 1 to 6
(14) gender
(15) transfusion (> 4 units before, > 4 units after, any during surgery)
(16) duration of surgery in minutes, from 0 to 480 minutes
points for age in years =
= (0.003254 * ((age)^2)) - (0.6413 * (age)) + 31.32
points for serum creatinine =
= MAX(0,(6.504 * (creatinne)) - 0.639)
points for serum albumin =
= (-0.9518 * ((albumin)^2)) + (2.114 * (albumin)) + 21.77
points for BMI =
= (0.04857 * (BMI)) - 0.72857
|
Duration |
Points |
|
0 to 120 |
(0.4333 * (minutes)) |
|
120 to 180 |
(-0.00111 * ((minutes)^2)) + (0.6333 * (minutes)) - 8 |
|
180 to 480 |
(0.09605 * (minutes)) + 54.75 |
|
Parameter |
Findings |
Points |
|
surgical site |
colon |
0 |
|
|
small bowel |
4.5 |
|
|
rectum |
6.7 |
|
smoker |
no |
0 |
|
|
yes |
13.6 |
|
ASA class |
1 |
6.9 |
|
|
2 |
0 |
|
|
3 |
3.4 |
|
|
4 or 5 |
21 |
|
diabetes |
no |
0 |
|
|
yes |
9 |
|
steroid therapy |
no |
0 |
|
|
yes |
10.3 |
|
prior surgery |
no |
0 |
|
|
yes |
28.2 |
|
radiotherapy |
no |
0 |
|
|
yes |
8.8 |
|
technique |
laparoscopic |
0 |
|
|
open |
12.6 |
|
gender |
female |
0 |
|
|
male |
0.5 |
|
transfusion |
no |
0 |
|
|
yes |
16.1 |
|
wound class |
1 or 2 |
0 |
|
|
3 (contaminated) |
19.3 |
|
|
4 (dirty) |
26.3 |
total score =
= SUM(points for all 16 parameters)
Interpretation:
• minimum total score: 0
• maximum score: around 339
|
Total Score |
30-Day Infection Risk |
|
< 70 |
< 1% |
|
70 to 150 |
(0.000506 * ((points)^2)) - (0.06103 * (points)) + 2.785 |
|
150 to 206 |
(0.00144 * ((points)^2)) - (0.3352 * (points)) + 22.95 |
|
206 to 327 |
(0.000929 * ((points)^2)) - (0.0261 * (points)) - 19.71 |
|
> 327 |
> 70% |
Performance:
• The concordance index with the 2007 ACS-NSQIP was 0.65.
Specialty: Infectious Diseases
