Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Risk factors for surgical site infections in older people. Surgical site infections in Italian Hospitals: a prospective multicenter study Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. [Incidence of surgical wound infections a prospective study in the Rabat Mohamed-V military hospital, Morocco]. Risk factors for surgical site infection after low transverse cesarean section. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Investigation of risk factors for surgical wound infection among teaching hospitals in Tehran. Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Risk factors for neurosurgical site infections: an 18-month prospective survey. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia. Elective Colon and Rectal Surgery Differ in Risk Factors for Wound Infection: Results of Prospective Surveillance Risk factors for surgical site infections after pediatric cardiovascular surgery Risk factors for surgical site infection after cardiac surgery in children. Surgical site infections: reanalysis of risk factors.
BACKGROUND  Surgical site infections ( SSIs ) are complications of surgery that cause significant postoperative morbidity . SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets . OBJECTIVES We aim ed to address a number of objectives . Firstly , identify risk factors for SSI , criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance ( PDS ) . Secondly , test the importance of risk factors for SSI in surveillance data bases and investigate interactions between risk factors . Thirdly , investigate and vali date different definitions of SSI . Lastly , develop models for making risk-adjusted comparisons between hospitals . DATA SOURCES A single hospital surveillance data base was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service data base to address objective 4 . STUDY DESIGN There were four elements to the research : ( 1 ) systematic review s of risk factors for SSI ( two review ers assessed titles and abstract s of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale ) ; ( 2 ) assessment of agreement between four SSI definitions ; ( 3 ) validation of definitions of SSI , quantifying their ability to predict clinical outcomes ; and ( 4 ) development of operation-specific risk models for SSI , with hospitals fitted as r and om effects . RESULTS Review s of SSI risk factors other than established SSI risk indices identified other risk ; some were operation specific , but others applied to multiple operations . The factor most commonly identified was duration of preoperative hospital stay . The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution . There was wide variation in SSI rate ( SSI% ) using different definitions . Over twice as many wounds were classified as infected by one definition only as were classified as infected by both . Different SSI definitions also classified different wounds as being infected . The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes . This finding is paradoxical given the poor agreement between definitions . Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both . Risk factors fitted in multivariable models and their effects , including age and gender , varied by surgical procedure . Operative duration was an important risk factor for all operations , except for hip replacement . Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers . The American Association of Anesthesiologists class was a consistent risk factor for most operations . CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined . SSI definitions varied between surveillance programmes and potentially between hospitals . Different definitions do not have good agreement , but the definitions have similar ability to predict outcomes influenced by SSI . Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures . There was no evidence for effect modification by hospital . Estimates of SSI% should be disseminated within institutions to inform infection control . Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care . Future research should focus on developing an SSI definition that has satisfactory psychometric properties , that can be applied in everyday clinical setting s , includes PDS and is formulated to detect SSIs that are important to patients or health services . FUNDING The National Institute for Health Research Technology Assessment programme OBJECTIVES To identify risk factors for  surgical site infection ( SSI ) in older people and to test a priori hypotheses regarding particular variables and SSI risk . DESIGN Case-control study . SETTING Duke University Medical Center and seven community hospitals in North Carolina and Virginia . PARTICIPANTS Elderly patients ( > or = 65 ) who underwent surgery between 1991 and 2002 at the study hospitals . Cases were elderly patients with SSI ; controls were elderly operative patients without SSI . Infection control practitioners prospect ively identified patients . MEASUREMENTS Data were collected retrospectively . Case patients who developed SSI were compared with control patients who did not develop SSI . RESULTS Five hundred sixty-nine SSI cases were identified , and 589 uninfected controls were selected . In multivariate analysis , independent predictors of SSI included obesity ( odds ratio (OR)=1.77 , 95 % confidence interval (CI)=1.34 - 2.32 ) , chronic obstructive pulmonary disease ( COPD ) ( OR=1.66 , 95 % CI=1.17 - 2.34 ) , and a wound class classified as contaminated or dirty ( OR=1.65 , 95 % CI=1.01 - 2.72 ) . Having private insurance was associated with lower risk ( OR=0.29 , 95 % CI=0.12 - 0.68 ) . CONCLUSION This study identified several independent predictors of  SSI in older people , including comorbid conditions ( COPD and obesity ) , perioperative variables ( wound class ) , and socioeconomic factors ( private insurance , which was associated with lower risk ) . The results from this study can be used to design and implement interventions for SSI prevention in high-risk older people Background Surgical site infections ( SSI ) remain a major clinical problem in terms of morbidity , mortality , and hospital costs . Nearly 60 % of SSI diagnosis occur in the postdischarge period . However , literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence . A national prospect i ve multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI , and the associated risk factors . Methods In 2002 , a one-month , prospect i ve national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals . Case ascertainment of SSI was carried out using st and ardized surveillance methodology . To assess potential risk factors for SSI we used a conditional logistic regression model . We also reported the odds ratios of in-hospital and postdischarge SSI . Results SSI occurred in 241 ( 5.2 % ) of 4,665 patients , of which 148 ( 61.4 % ) during in-hospital , and 93 ( 38.6 % ) during postdischarge period . Of 93 postdischarge SSI , sixty-two ( 66.7 % ) and 31 ( 33.3 % ) were detected through telephone interview and question naire survey , respectively . Higher SSI incidence rates were observed in colon surgery ( 18.9 % ) , gastric surgery ( 13.6 % ) , and appendectomy ( 8.6 % ) . If considering risk factors for SSI , at multivariate analysis we found that emergency interventions , NNIS risk score , pre-operative hospital stay , and use of drains were significantly associated with SSI occurrence . Moreover , risk factors for total SSI were also associated to in-hospital SSI . Additionally , only NNIS , pre-operative hospital stay , use of drains , and antibiotic prophylaxis were associated with postdischarge SSI . Conclusion Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy . St and ardized postdischarge surveillance detected 38.6 % of all SSI . We also compared risk factors for in-hospital and postdischarge SSI , thus providing additional information to that of the current available literature . Finally , a large amount of postdischarge SSI were detected through telephone interview . The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research Objective To identify the risk factors for surgical site infection ( SSI ) in patients undergoing elective resection of the colon and rectum . Summary Background Data SSI causes a substantial number of deaths and complications . Determining risk factors for SSI may provide information on reducing complications and improving outcome . Methods The authors performed a prospect i ve study of 2,809 consecutive patients undergoing elective colorectal resection via laparotomy between February 1995 and December 1998 at a single institution . The outcome of interest was SSI , which was classified as being incisional or organ/space with or without clinical leakage . A likelihood ratio forward regression model was used to assess the independent association of variables with SSIs . Results The overall SSI , incisional SSI , and organ/space SSI with and without clinical anastomotic leakage rates were 4.7 % , 3 % , 2 % , and 0.8 % , respectively . Risk factors for overall SSI were American Society of Anesthesiology ( ASA ) score 2 or 3 ( odd ratio [ OR ] = 1.7 ) , male gender ( OR = 1.5 ) , surgeons ( OR = 1.3–3.3 ) , types of operation ( OR = 0.3–2.1 ) , creation of ostomy ( OR = 2.1 ) , contaminated wound ( OR = 2.9 ) , use of drainage ( OR = 1.6 ) , and intra- or postoperative blood transfusion ( 1–3 units , OR = 5.3 ; ≥4 units , OR = 6.2 ) . However , SSIs at specific sites differed from each other with respect to the risk factors . Among a variety of risk factors , only blood transfusion was consistently associated with a risk of SSI at any specific site . Conclusions In addition to ASA score and surgical wound class , blood transfusion , creation of ostomy , types of operation , use of drainage , sex , and surgeons were important in predicting SSIs after elective colorectal resection BACKGROUND The Victorian Infection Control Surveillance Project ( VICSP ) is a multicenter collaborative surveillance project established by infection control practitioners . Five public hospitals contributed data for patients undergoing coronary artery bypass graft ( CABG ) surgery .  OBJECTIVE To determine the aggregate and comparative interhospital surgical-site infection ( SSI ) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group . METHOD Each institution used st and ardized definitions of SSI , risk adjustment , and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention . Data on potential risk factors were prospect ively collected . RESULTS For 4,474 patients undergoing CABG surgery , the aggregate SSI rate was 7.8 infections per 100 procedures ( 95 % confidence interval [ CI95 ] , 7.0 - 8.5 ) , with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures . Multivariate risk factor analysis demonstrated age ( odds ratio [ OR ] , 1.02 ; CI95 , 1.01 - 1.04 ; P < .001 ) , obesity ( OR , 1.8 ; CI95 , 1.4 - 2.3 ; P < .001 ) , and diabetes mellitus ( OR , 1.6 ; CI95 , 1.2 - 2.1 ; P < .001 ) as independent predictors of SSI . Three hundred thirty-four organisms were isolated from 296 SSIs . Of the total SSIs , methicillin-resistant Staphylococcus aureus was isolated from 32 % , methicillin-sensitive S. aureus from 24 % , gram-negative bacilli ( eg , Enterobacter and Escherichia coli ) from 18 % , and miscellaneous organisms from the remainder . CONCLUSION We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI . VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery OBJECTIVES The authors had for aim to determine prospect ively the incidence of surgical site infections ( SSI )  in a visceral surgery department , in the Mohamed V military hospital ( Rabat ) , and to identify risk factors . PATIENTS AND METHODS All patients who had undergone surgery between April 1 and September 30 , 2002 and were then admitted in the visceral surgery unit were included in this study . Patients were assessed within the following month . For each patient , data including perioperative factors , type of procedure , and SSI occurrence were collected on a st and ardized form . RESULTS During the study , 310 patients were operated . The number of surgical wound infections was 16 ( 5.2 % ) . This analysis pointed out : 11 superficial wounds , 5 deep wounds , and 1 organ/site wound . Emergency , age , ASA score , Altemeier classification , and procedure duration were found to be risk factors for SSI in visceral surgery . According to the NNIS index , SSI rates increase from 2.7 % for patients with a risk index of 0 to 10.2 % for patients with a risk index of 3 . CONCLUSION The high incidence of SSI emphasizes the importance of implementing SSI surveillance in surgery to obtain st and ardized incidence ratios necessary for adapted control measures BACKGROUND Independent risk factors for surgical site infection ( SSI ) after cesarean section have not been well documented , despite the large number of cesarean sections performed and the relatively common occurrence of SSI . OBJECTIVE To determine independent risk factors for SSI after low transverse cesarean section . DESIGN Retrospective case-control study . SETTING Barnes-Jewish Hospital , a 1,250-bed tertiary care hospital . PATIENTS A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001 . METHODS Using the International Classification of Diseases , Ninth Revision , Clinical Modification diagnosis codes for SSI or wound complication and /or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department , we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section .  Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention 's National Nosocomial Infections Surveillance System . Control patients without SSI or endomyometritis were r and omly selected from the population of patients who underwent cesarean section . Independent risk factors for SSI were determined by logistic regression . RESULTS SSIs were identified in 81 ( 5.0 % ) of 1,605 women who underwent low transverse cesarean section . Independent risk factors for SSI included development of subcutaneous hematoma after the procedure ( adjusted odds ratio [ aOR ] , 11.6 [ 95 % confidence interval [ CI ] , 4.1 - 33.2 ] ) , operation performed by the university teaching service ( aOR , 2.7 [ 95 % CI , 1.4 - 5.2 ] ) , and a higher body mass index at admission ( aOR , 1.1 [ 95 % CI , 1.0 - 1.1 ] ) . Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI ( aOR , 0.2 [ 95 % CI , 0.1 - 0.5 ] ) . Use of staples for skin closure was associated with a marginally increased risk of SSI . CONCLUSIONS These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery BACKGROUND Surveillance of surgical site infection ( SSI ) is one of the most effective methods for decreasing the incidence . We determined the risk factors for SSI and the effect of a one-year surveillance program on the rate at a tertiary-care center . METHODS The annual SSI rate before the study period was determined in a preliminary study . Risk factors related to SSI , the bacteria cultured from infected sites , and the effect of surveillance were then analyzed prospect ively . Risk factors were determined by logistic regression analysis , and 95 % confidence intervals were calculated . RESULTS The incidence of SSI decreased from 12.8 % before the study to 8.8 % at the end of the surveillance period . There were 90 SSIs ( 8.8 % ) in 1,017 procedures during the study period , most of which ( 77 ; 69 % ) were detected during the hospital stay . The distribution of superficial incisional , deep incisional , and organ/space SSI was 61.1 % , 33.4 % , and 5.5 % , respectively . Prolonged preoperative hospital stay ( > 8 days ) , abdominal incision , early preoperative hair removal , inappropriate antimicrobial prophylaxis , whole blood transfusion , famotidine treatment , repair with mesh , age > 75 years , wound contamination , high American Society of Anesthesiologists score , malnutrition , diabetes mellitus , emergency surgery , obesity , and coexistent infection proved to be independent risk factors for SSI , whereas the skin closure technique , patient sex , presence of malignancy , smoking history , and duration of operation were not . Staphylococcus aureus and Escherichia coli were the bacteria isolated most frequently . Six infected patients ( 5.4 % ) died , four because of SSI . Development of SSI increased hospital expenses by around 600 US dollars per patient . CONCLUSION Surveillance even for one year decreases the incidence of SSI This prospect i ve study was carried out to investigate the risk factors and incidence of surgical site infection ( SSI ) among patients in surgical wards of five hospitals affiliated to Iran University of Medical Sciences . Data was collected in a register card filled by specially trained staff . Nine-hundred and eighteen patients admitted in surgical wards were followed 30 days postoperatively for SSI during 1 April 2003 to 30 September 2003 . A total of 77 patients were identified among 918 cases included in the study , with a result ing overall SSI rate of 8.4 % . The risk of SSI was increased by age older than 60 years ( OR = 3.9 ; P < 0.0001 ) , diabetes mellitus ( OR = 4.9 ; P < 0.0001 ) , smoking ( OR = 3.1 ; P < 0.0001 ) , obesity ( OR = 4.1 ; P < 0.0001 ) and wound drain ( OR = 2.2 ; P < 0.0001 ) . There were significant statistical difference in duration of anaesthesia ( 131.6 vs. 177 min , P < 0.001 ) and duration of surgery ( 99 vs. 140.5 ) between patients without SSI and patients with SSI . In conclusion , identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality and morbidity and hospital care costs of surgery patients BACKGROUND CONTEXT Surgical site infection ( SSI ) is one of the most serious complications of spine surgery . Its predisposing factors , especially in routine surgeries , are less reported . However , a number of patient- and procedure-related risk factors could be avoided or at least determined preoperatively . Moreover , the patient-specific risk for SSI could be estimated before the elective surgery . PURPOSE The aim of the present study was to analyze the preoperatively determinable risk factors for SSI in patients who require elective routine surgery related to lumbar disc degeneration and to build a multivariable model for the individual risk prediction . STUDY DESIGN Analysis of prospect ively collected st and ardized clinical data and the validation of the results on an independent prospect i ve cohort were performed . PATIENT SAMPLE One thous and thirty ( N=1,030 ) patients were included in the study . All subjects underwent primary lumbar single- or two-level decompression , microdiscectomy , or instrumented fusion .  OUTCOME MEASURES Occurrence of an SSI defined according to the current Centers for Disease Control and Prevention guidelines that required surgical or nonsurgical therapy . METHODS The effect of preoperative patient characteristics , comorbidities , disease history , and invasiveness of the elective surgery on the risk of SSI was determined in uni- and multivariate logistic regression models in the test cohort ( N=723 ) . The performance of the final multivariable regression model was assessed by measuring its discriminative ability ( c-index ) in receiver operating characteristic analysis . Performance of the multivariable risk estimation model was tested on the validation ( N=307 ) cohort . RESULTS The prevalence of SSI was 3.5 % and 3.9 % in the test and in the validation cohorts , respectively . The final multivariable regression model predictive ( p=.003 ) for SSI contained the patient 's age , body mass index ( BMI ) , and the presence of 5 comorbidities , such as diabetes , ischemic heart disease , arrhythmia , chronic liver disease , and autoimmune disease as risk factors . The c-index of the model was 0.71 , showing good discriminative ability , and it was confirmed by the data of the independent validation cohort ( c=0.72 ) . CONCLUSIONS Predisposing factors for SSI were older age , higher BMI , and the presence of certain comorbidities in the present study . The cumulative number of risk factors significantly associated with the increasing risk for an SSI ( p<.0001 ) . Our model needs further validation but it may be used for individual risk assessment and reduction in the future OBJECT The purpose of this study was to determine the incidence rate and risk factors of surgical site infections ( SSIs ) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class . METHODS The authors undertook an exhaustive 18-month prospect i ve survey including patients who underwent neurosurgery .  In particular , a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant , and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant . The Centers for Disease Control definition of SSI was used . Univariate and multivariate analyses were conducted ; all dependent variables found in univariate analysis were entered in the multiple regression model . A stepwise multiple logistic regression method was used . RESULTS Of the 844 patients studied , 35 SSIs were diagnosed , yielding an incidence rate of 4.1 % ( 95 % confidence interval 3.6 - 4.5 ) . Independent predictive risk factors for infection were cerebrospinal fluid leakage , external shunt , Altemeier class , and further neurosurgery . A lack of antibiotic prophylaxis was not found to be a risk factor . CONCLUSIONS Infection risk factors occur mainly during the postoperative period Abstract Background : Abdominal surgeries have high rates of surgical site infections ( SSIs ) , contributing to increased morbidity and mortality and costs for hospitalization . The aim of this study was to determine the SSI incidence rates and risk factors after  abdominal surgeries .  Methods : This prospect i ve cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya , Israel .  SSI incidence rates were calculated per 100 operations . Odds ratios ( ORs ) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models . Results : Among 302 patients in the study cohort , the total SSI incidence rate was 22.2 % . The univariate analysis defined 13 variables significantly associated with SSI : age > 60 years , lower functional status , diabetes mellitus , congestive heart failure , immunocompromising underlying disease , treatment with chemotherapy and other immunosuppressive medications , impaired immune system open cholecystectomy , laparotomy , an American Society of Anesthesiologists ( ASA ) score > 2 , drain insertion , and ‘ dirty wound ’ classification . In multivariate regression analysis , treatment with immunosuppressive medications ( OR = 2.5 , 95 % confidence interval ( CI ) = 1.099–143.443 ) , open cholecystectomy ( OR = 2.25 , 95 % CI = 2.242–40.109 ) , and dirty wound classification ( OR = 2.179 , 95 % CI = 3.80–20.551 ) were significantly associated with SSI . Conclusions : The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI . Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates OBJECTIVES To estimate the frequency of and risk factors for surgical-site infections ( SSIs ) in Bolivia , and to study the performance of the National Nosocomial Infections Surveillance ( NNIS ) System risk index in a developing country . DESIGN A prospect i ve study with patient follow-up until the 30th postoperative day . SETTING A general surgical ward of a public hospital in Santa Cruz , Bolivia . PATIENTS Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed . RESULTS Follow-up was complete for 91.5 % of 376 surgical procedures . The overall SSI rate was 12 % . Thirty-four ( 75.6 % ) of the 45 SSIs were culture positive . A logistic regression model retained an American Society of Anesthesiologists score of more than 1 ( odds ratio [ OR ] , 1.87 ) , a not-clean wound class ( OR , 2.28 ) , a procedure duration of more than 1 hour ( OR , 1.81 ) , and drain ( OR , 1.98 ) as independent risk factors for SSI . There was no significant association between the NNIS System risk index and SSI rates . However , a " local " risk index constructed with the above cutoff points showed a linear trend with SSI ( P < .001 ) and a relative risk of 3.18 for risk class 3 versus a class of less than 3 . CONCLUSIONS SSIs cause considerable morbidity in Santa Cruz . Appropriate nosocomial infection surveillance and control should be introduced . The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting , but a risk score based on local cutoff points performed substantially better Objective : The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection ( SSI ) in both elective colon and rectal surgery . Summary Background Data : SSI is a frequent complication after elective colorectal resection . The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together , without differentiating the type of colorectal surgery performed . However , rectal surgery may have a higher risk for SSI , and identifying risk factors that are more specific to each procedure would be more predictive . Methods : We conducted prospect i ve SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004 . The data for colon and rectal surgeries were collected separately . The outcome of interest was incisional SSI . Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery . Results : A total of 556 colorectal resections , consisting of 339 colon and 217 rectal surgeries , were admitted to the program . The incisional SSI rates in colon and rectal surgeries were 9.4 % and 18.0 % , respectively ( P = 0.0033 ) . Risk factors for developing incisional SSI in colon surgery were ostomy closure ( OR = 7.3 ) and lack of oral antibiotics ( OR = 3.3 ) , while in rectal surgery , risk factors were preoperative steroids ( OR = 3.7 ) , preoperative radiation ( OR = 2.8 ) , and ostomy creation ( OR = 4.9 ) . Conclusions : Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI . SSI surveillance for such surgeries should be performed separately , as this should lead to more efficient identification of risk factors and a reduction in SSI Background . Although risk factors for surgical site infection ( SSI ) after cardiovascular ( CV ) surgery have been well-documented among adults , few studies have been conducted in children . We performed a case-control study to identify risk factors for hospitalized SSI in children undergoing CV surgery .  Methods . National Nosocomial Infections Surveillance System criteria were used prospect ively to identify cases of hospitalized SSI in patients who underwent CV surgery . Seventy-nine patients who underwent CV surgery without hospitalized SSI were r and omly selected as controls . Cases were compared with controls to determine preoperative , intraoperative and postoperative risk factors for hospitalized SSI . Multivariable logistic regression was performed . Results . An SSI developed in 19 of the 826 patients who underwent CV surgery  ( 2.3 cases per 100 surgeries ) during the study period . Infection was limited to soft tissue in 12 , whereas deeper infection occurred in 7 . Causative agents included Staphylococcus aureus ( 11 ) , coagulase-negative Staphylococcus ( 5 ) and Escherichia coli ( 2 ) . One patient did not have a pathogen isolated . In a multivariable analysis , duration of surgery ( odds ratio , 1.4 ; 95 % confidence interval , 1.2 to 1.8 ) and age < 1 month ( odds ratio , 14 ; 95 % confidence interval , 3.3 to 58.4 ) were independently associated with SSI . Conclusions . Age < 1 month and longer duration of surgery were independently associated with hospitalized SSI after CV surgery in children BACKGROUND We sought to identify risk factors for surgical site infections ( SSI ) in children undergoing cardiac surgery . METHODS A matched case-control study was conducted in the Children 's Hospital Boston Cardiovascular Program . Surgical site infections were identified for 3 years ( 2004 to 2006 ) . We identified two r and omly selected control patients who underwent cardiac surgery within 7 days of each index case .  Univariate and multivariate conditional logistic regression analyses were used to identify risk factors for SSI . In a secondary analysis , risk factors for organ space SSI ( mediastinitis ) were sought . Secondary analyses were also conducted using only those variables known preoperatively . RESULTS Seventy-two SSI and 144 controls were included . Independent risk factors for any type of SSI were age younger than 1 year ( adjusted odds ratio , 2.28 ; 95 % confidence interval , 1.18 to 4.39 ) and duration of cardiopulmonary bypass greater than 105 minutes ( adjusted odds ratio , 1.92 ; 95 % confidence interval , 1.02 to 3.62 ) . Independent risk factors for organ space SSI were aortic cross-clamp time greater than 85 minutes ( adjusted odds ratio , 5.61 ; 95 % confidence interval , 1.06 to 29.67 ) and postoperative exposure to at least three separate red blood cell transfusions ( adjusted odds ratio , 7.87 ; 95 % confidence interval , 1.63 to 37.92 ) . When only those potential risk factors known preoperatively were considered , age younger than 1 year independently predicted the subsequent development of any type of SSI , and preoperative hospitalization independently predicted the subsequent development of organ space SSI . CONCLUSIONS Younger patients undergoing longer surgical procedures and those requiring more postoperative blood transfusions are at greatest risk for SSI . Additional preventive strategies , including restrictive blood transfusion policies , warrant further investigation BACKGROUND Surgical site infections ( SSI ) are the most common nosocomial infection in surgical patients , accounting for 38 % of all such infections , and are a significant source of postoperative morbidity result ing in increased hospital length of stay and increased cost . During 1986 - 1996 the Center for Disease Control and Prevention 's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations ( 2.6 % ) . Previous studies have documented patient characteristics associated with an increased risk of SSI , including diabetes , tobacco or steroid use , obesity , malnutrition , and perioperative blood transfusion . In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients . METHODS Prospect i ve data ( NSQIP ) were collected on 5031 noncardiac surgical patients at the Veteran 's Administration Maryl and Healthcare System from 1995 to 2000 . All preoperative risk factors were evaluated as independent predictors of surgical site infection . RESULTS The mean age of the study cohort was 61 plus minus 13 .  SSI occurred in 162 patients , comprising 3.2 % of the study cohort . Gram-positive organisms were the most common bacterial etiology . Multiple logistic regression analysis documented that diabetes ( insulin- and non-insulin-dependent ) , low postoperative hematocrit , weight loss ( within 6 months ) , and ascites were significantly associated with increased SSI . Tobacco use , steroid use , and chronic obstructive pulmonary disease ( COPD ) were not predictors for SSI . CONCLUSION This study confirms that diabetes and malnutrition ( defined as significant weight loss 6 months prior to surgery ) are significant preoperative risk factors for SSI . Postoperative anemia is a significant risk factor for SSI . In contrast to prior analyses , this study has documented that tobacco use , steroid use , and COPD are not independent predictors of SSI . Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition
Surgical associated factors — preoperative radiation/postoperative blood transfusion , combined anterior/posterior approach , surgical invasiveness , or levels of instrumentation were associated with increased SSI .
There is mixed evidence of age , duration of surgery , surgical team , intraoperative blood loss , dural tear , and urinary tract infection/urinary catheter in association with SSI .
Conclusion : SSIs are associated with many risk factors that can be patient or surgically related .
Objective : To perform a review of SSI risk factors and more specifically , categorize them into patient and surgical factors .