Development and Validation of a Novel Stratification Tool for Identifying Cancer Patients at Increased Risk of Surgical Site Infection
To identify cancer-specific predictors of postoperative surgical site infection (SSI), and to develop a risk-stratification prognostic tool and compare its performance with traditional measures.Background:
The incidence and risk factors for SSI in cancer patients are unknown; current risk-stratification tools are not cancer-specific.Methods:
A prospective cohort study of patients undergoing elective operations (n = 503) at a tertiary cancer center was conducted. SSI was assessed using postdischarge active surveillance. Multivariate logistic regression analyses were performed to identify predictors of SSI, and β-coefficients were used to create a scoring system. The sum of these was used to create a Risk of Surgical Site Infection in Cancer (RSSIC) score. The RSSIC was validated using bootstrapping techniques, and its discrimination was compared with the National Nosocomial Infection Surveillance (NNIS) risk index.Results:
The 30-day SSI incidence was 24%. Significant predictors of SSI included preoperative chemotherapy (OR = 1.94 [95% CI, 1.16–3.25]), clean-contaminated wounds (OR = 2.1 [95% CI, 1.24–3.55]), operative time ≥2 hours (OR = 1.75 [95% CI, 1.01–3.04]) and ≥4 hours (OR = 2.24 [95% CI, 1.22–4.1]), and surgical site: groin (OR = 4.65 [95% CI, 1.69–12.83]), and head/neck (OR = 0.12 [95% CI, 0.02–0.89]). The RSSIC score stratified patients into 4 risk strata for SSI. The performance of this score exceeded that of the NNIS score (AUC = 0.70 vs. 0.63, respectively; P = 0.01).conclusion:
SSIs are common following cancer surgery. Preoperative chemotherapy, in addition to other common risk factors, was identified as a significant predictor for SSI in cancer patients. The RSSIC improves risk-stratification of cancer patients and identifies those that may benefit from more aggressive or novel preventive strategies.