Purpose: The American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) created a prediction model for surgical site infection(SSI). This ASC-NSQIP model is for superficial, deep and organ space SSI(OrgSSI). Most SSI are superficial and cause less severe morbidity than OrgSSI (abdominal or pelvic abscess). We hypothesized that OrgSSI are a unique type of SSI and therefore they are associated with a unique set of risk factors. The aim of our study was to create a predictive model for OrgSSI after small bowel, colon and rectal surgeries.Methods: The 2006 ACS-NSQIP sample(N=12,373) was used to identify the CPT codes for small bowel, colon and rectal laparoscopic(Lx) or open surgical procedures. The following variables were used to build a predictive model of OrgSSI within 30 days post-op: age, gender, BMI, ASA class, smoking, diabetes, steroid use, 30 days previous radiotherapy or surgery, preoperative creatinine and albumin, Lx, wound class, perioperative transfusion, operative time and surgical site. Patients on chronic mechanical ventilation, dialysis, wound infection or sepsis preoperatively were excluded. Results: Our OrgSSI model achieved a C-index of 0.65 when validated in 2007 NSQIP patients(N=7,802). The point value for each variable in the nomogram indicates its relative weight in predicting OrgSSI. A risk calculator designed with our model is available at: http://simpal.com/rcc/links/orgssi.html Conclusion: This novel and validated nomogram is useful to predict OrgSSI associated with small bowel, colon and rectal surgical procedures. Risk stratification and risk modification are potential uses of this nomogram.


Nomogram predictor of OrgSSI