Finding a Method for Optimizing Risk Adjustment When Comparing Surgical-Site Infection Rates

2004 ◽  
Vol 25 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Christian Brandt ◽  
Sonja Hansen ◽  
Dorit Sohr ◽  
Franz Daschner ◽  
Henning Rüden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Regression Models ◽  
Predictive Power ◽  
Risk Index ◽  
Significant Risk ◽  
Site Infection ◽  
Logistic Regression Models ◽  
System Risk

AbstractObjective:To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index.Design and Setting:The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations).Methods:For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models.Results:For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index.Conclusion:Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.

scholarly journals Risk factors associated with stillbirth of piglets born from oxytocin-assisted parturitions

2020 ◽  
Vol 13 (10) ◽  
pp. 2172-2177
Author(s):  
Nguyen Hoai Nam ◽  
Peerapol Sukon
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Models ◽  
Significant Risk ◽  
Gestation Length ◽  
Stillbirth Rate ◽  
Multivariate Logistic Regression ◽  
Crown Rump Length ◽  
Logistic Regression Models ◽  
Factors Associated

Aim: The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions. Materials and Methods: Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing. Results: The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets. Conclusion: Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.

Surgical-Site Infection After Cardiac Surgery: Incidence, Microbiology, and risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 466-472 ◽  
Author(s):  
Didier Lepelletier ◽  
Stéphanie Perron ◽  
Philippe Bizouarn ◽  
Jocelyne Caillon ◽  
Henri Drugeon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Site Infection ◽  
Internal Mammary ◽  
System Risk

AbstractObjective:To identify risk factors associated with surgical-site infection according to the depth of infection, the cardiac procedure, and the National Nosocomial Infections Surveillance System risk index.Design:Prospective survey conducted during a 12-month period.Setting:A 48-bed cardiac surgical department in a teaching hospital.Patients:Patients admitted for cardiac surgery between February 2002 and January 2003.Results:Surgical-site infections were diagnosed in 3% of the patients (38 of 1,268). Of the 38 surgical-site infections, 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6% and 1.4%, respectively. Cultures were positive in 28 cases and the most commonly isolated pathogen wasStaphylococcus. A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection (relative risk, 2.4;P< .004). Heart transplantation, mechanical circulatory assistance, coronary artery bypass graft with the use of internal mammary artery, and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection.Conclusions:Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts. Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis. Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection, and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection.

scholarly journals Significant Risk Factors Associated With Stunting for Children Under the Age of 5-years in Malawi: the Application of Proportional Odds Model Using DHS Datasets.

2021 ◽  
Author(s):  
Mzwakhe Magagula ◽  
Shaun Ramroop ◽  
Faustin Habyarimana
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Models ◽  
Linear Models ◽  
Medical Condition ◽  
Significant Risk ◽  
Proportional Odds ◽  
Data Set ◽  
Logistic Regression Models ◽  
Factors Associated

Abstract BackgroundChild malnutrition is perhaps the one of the main medical condition influencing general human wellbeing, mainly in non-industrial nations. The improvement of legitimate evaluations of malnutrition is one of the difficulties encountered by policymakers in numerous countries worldwide. In this manner, the current study was embraced with the essential goal of evaluating and determining all potential determinants of childhood malnutrition in Malawi, using the Demographic and Health Survey (DHS) data 2015/16. The study seeks to reveal some of the significant factors that are perpetuating the incidence of malnutrition in children of Malawi. It also designed to offer deeper insights on how the probability of being diagnosed with this medical condition (malnutrition) evolves across the different levels of the found significant factors.Methods The proportional odds (PO) model was the best model to utilize, motivated by the design of the current study's data set. The PO model is an alternative to conceptualize how the ordinal designed data can be sequentially into dichotomous groups without losing the ordinal nature of response variables. The model is an extension of logistic regression models with two outcomes, it is one of the best models to deal with ordinal response variable comprising of more than two categories. The PO model, as well as the logistic regression models are common classes of generalised linear models (GLMs) mostly used to model association between dependent variable and independent variables. ResultsThe observations derived from fitting the PO model on the Malawi DHS data to investigate risk factors associated with malnutrition (stunting) suggested that: the age of the child; birth type (singleton/multiple births), parents' level of education, household's type of resident; mother's age at the time of birth, mother's BMI, incident of diarrhoea in the last two weeks before the survey, are the most significant independent risk factors of malnutrition (stunting). ConclusionsAll the aforementioned risk factors are controllable, and they can be improved through intervention strategies. The policies that undergird the country are required to counteract this condition, as the majority of the risk factors need the coherent actions of several governing authorities.

Improved Risk Adjustment for Comparison of Surgical Site Infection Rates

2006 ◽  
Vol 27 (12) ◽  
pp. 1330-1339 ◽  
Author(s):  
Eveline L. P. E. Geubbels ◽  
Diederick E. Grobbee ◽  
Christina M. J. E. Vandenbroucke-Grauls ◽  
Jan C. Wille ◽  
Annette S. de Boer
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Risk Adjustment ◽  
Predictive Power ◽  
Hip Prosthesis ◽  
Risk Index ◽  
Site Infection ◽  
Total Hip Prosthesis ◽  
Infection Surveillance ◽  
Femorotibial Bypass

Objective.To develop prognostic models for improved risk adjustment in surgical site infection surveillance for 5 surgical procedures and to compare these models with the National Nosocomial Infection Surveillance system (NNIS) risk index.Design.In a multicenter cohort study, prospective assessment of surgical site infection and risk factors was performed from 1996 to 2000. In addition, risk factors abstracted from patient files, available in a national medical register, were used. The c-index was used to measure the ability of procedure-specific logistic regression models to predict surgical site infection and to compare these models with models based on the NNIS risk index. A c-index of 0.5 indicates no predictive power, and 1.0 indicates perfect predictive power.Setting.Sixty-two acute care hospitals in the Dutch national surveillance network for nosocomial infections.Participants.Patients who underwent 1 of 5 procedures for which the predictive ability of the NNIS risk index was moderate: reconstruction of the aorta (n= 875), femoropopliteal or femorotibial bypass (n= 641), colectomy (n= 1,142), primarytotal hip prosthesis (n= 13,770), and cesarean section (n= 2,962).Results.The predictive power of the new model versus the NNIS index was 0.75 versus 0.62 for reconstruction of the aorta (P&lt; .01), 0.78 versus 0.58 for femoropopliteal or femorotibial bypass (P&lt; .001), 0.69 versus 0.62 for colectomy (P&lt; .001), 0.64 versus 0.56 for primary total hip prosthesis arthroplasty (P&lt; .001), and 0.70 versus 0.54 for cesarean section (P&lt; .001).Conclusion.Data available from hospital information systems can be used to develop models that are better at predicting the risk of surgical site infection than the NNIS risk index. Additional data collection may be indicated for certain procedures–for example, total hip prosthesis arthroplasty.

Abstract 17220: Risk Factors for Recurrent Peripartum Cardiomyopathy in 783 Women in California

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Punag Divanji ◽  
Gregory Nah ◽  
Ian Harris ◽  
Anu Agarwal ◽  
Nisha I Parikh
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Regression Models ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Logistic Regression Models ◽  
Grand Multiparity ◽  
Adjusted Logistic Regression

Introduction: Characterized by significant left ventricular (LV) dysfunction and clinical heart failure (HF), peripartum cardiomyopathy (PPCM) has an incidence of approximately 1/2200 live births (0.04%). Prior studies estimate that approximately 25% of those with recovered LV function will have recurrent clinical PPCM during subsequent pregnancies, compared to 50% of those without recovered LV function. Specific predictors of recurrent PPCM have not been studied in cohorts with large numbers. Methods: From 2005-2011, we identified 1,872,227 pregnancies by International Classification of Diseases, 9th Revision (ICD-9) codes in the California Healthcare Cost and Utilization Project (HCUP) database, which captures over 95% of the California hospitalized population. Excluding 15,765 women with prior cardiovascular disease (myocardial infarction, coronary artery disease, stroke, HF, valve disease, or congenital heart disease), yielded n=1,856,462 women. Among women without prior cardiovascular disease, we identified index and subsequent pregnancies with PPCM to determine episodes of recurrent PPCM. We considered the following potential predictors of PPCM recurrence in both univariate and age-adjusted logistic regression models: age, race, hypertension, diabetes, smoking, obesity, chronic kidney disease, family history, pre-eclampsia, ectopic pregnancy, income, and insurance status. Results: In HCUP, n=783 women had pregnancies complicated by PPCM (mean age=30.8 years). Among these women, n=133 had a subsequent pregnancy (17%; mean age=28.1 years), with a mean follow-up of 4.34 years (±1.71 years). In this group of 133 subsequent pregnancies, n=14 (10.5%) were complicated by recurrent PPCM, with a mean time-to-event of 2.2 years (±1.89 years). Among the risk factors studied, the only univariate predictor of recurrent PPCM was grand multiparity, defined as ≥ 5 previous deliveries (odds ratio: 22; 95% confidence interval 4.43-118.22). The other predictors we studied were not significantly associated with recurrent PPCM in either univariate or multivariable models. Conclusion: In a large population database in California with 783 cases of PPCM over a 6-year period, 17% of women had a subsequent pregnancy, of which 10.5% had recurrent PPCM. In age-adjusted logistic regression models, grand multiparity was the only statistically significant predictor of recurrent PPCM.

scholarly journals Incidence and Risk Factors of Recipient Surgical Site Infection in Oral and Maxillofacial Reconstruction with Vascularized Fibular Bone Grafts

2020 ◽  
pp. 231
Author(s):  
Pichai Vittayakittipong ◽  
Sarocha Makmanee
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Significant Risk ◽  
Bone Grafts ◽  
Class Ii ◽  
P Value ◽  
Site Infection ◽  
Physical Status ◽  
Recipient Site ◽  
Maxillofacial Reconstruction

Objective: To determine the incidence and risk factors of recipient surgical site infection (RSSI) after oral and maxillofacial reconstruction with vascularized fibular bone grafts (VFBG).Material and Methods: This retrospective study was performed in patients who underwent oral and maxillofacial reconstructive surgery, with VFBG, at the Dental Hospital, Faculty of Dentistry, Prince of Songkla University. Demographic, preoperative, intraoperative and postoperative data were recorded. Any infection at the recipient site occurring within 30 days post-operatively, by criteria from the Center of Disease Control, was defined as RSSI. Statistical analysis was performed by chi-square test, Student's t-test and Pearson’s correlation coefficient with statistical significance was set at 0.05.Results: There were twenty-one patients who met the eligibility criteria. The incidence of RSSI after oral and maxillofacial reconstruction with VFBG was 47.6% (10/21 patients), and the success rate of VFBG was 95.2%. American Society of Anesthetics (ASA) physical status class II and oral contamination were significant risk factors for RSSI (p-value=0.004 and p-value=0.031, respectively). Length of hospital stay was significantly higher in the RSSI group (p-value<0.001).Conclusion: The incidence of RSSI after oral and maxillofacial reconstruction with VFBG was high, and ASA physical status class II and oral contamination were significant risk factors for RSSI.

scholarly journals Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xufei Zhang ◽  
Zhiwei Wang ◽  
Jun Chen ◽  
Peige Wang ◽  
Suming Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Large Scale ◽  
Risk Index ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Cross Sectional ◽  
Medical Expenses ◽  
Related Risk

Abstract Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

Forced Sexual Victimization Among Youth in Custody: Do Risk Factors Vary by Gender and Perpetrator?

2019 ◽  
Vol 100 (2) ◽  
pp. 151-172
Author(s):  
Eileen M. Ahlin
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Logistic Regression ◽  
National Survey ◽  
Regression Models ◽  
Sexual Victimization ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Using Data

There is relatively little literature examining risk factors associated with sexual victimization among youth in custody. The current study explored whether risk of forced sexual victimization among youth in custody differs by gender or perpetrator. Using data from a sample of 8,659 youth who participated in the National Survey of Youth in Custody, multivariate logistic regression models were employed to investigate gender differences in risk factors associated with overall forced sexual victimization and staff-on-inmate and inmate-on-inmate forced sexual victimization. Findings suggest that gender differences are more pronounced when perpetrator type is considered.

Surgical Site Infection in a Tertiary Neonatal Surgery Centre

2018 ◽  
Vol 29 (03) ◽  
pp. 260-265 ◽  
Author(s):  
Adiam Woldemicael ◽  
Sarah Bradley ◽  
Caroline Pardy ◽  
Justin Richards ◽  
Paolo Trerotoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Model ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Logistic Regression Model ◽  
Length Of Hospital Stay ◽  
Neonatal Surgery ◽  
Site Infection ◽  
Increased Risk

Introduction Surgical site infection (SSI) is a key performance indicator to assess the quality of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking in the literature. Aim To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery centre. Materials and Methods This is a prospective cohort study of all the neonates who underwent abdominal and thoracic surgery between March 2012 and October 2016. The variables analyzed were gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal intensive care unit, type of surgery, length of stay, and microorganisms isolated from the wounds. Statistical analysis was done with chi-square, Student's t- or Mann–Whitney U-tests. A logistic regression model was used to evaluate determinants of risk for SSI; variables were analyzed both with univariate and multivariate models. For the length of hospital stay, a logistic regression model was performed with independent variables. Results A total of 244 neonates underwent 319 surgical procedures. The overall incidence of SSIs was 43/319 (13.5%). The only statistical differences between neonates with and without SSI were preoperative stay (<4 days vs. ≥4 days, p < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p < 0.01). A pre-operative stay longer than 4 days was associated with almost three times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05–8.34, p = 0.0407). Gastrointestinal procedures were associated with more than ten times the risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82–27.10, p < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies had the highest incidence SSI (54% and 62%, respectively). The risk of longer length of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63–6.94, p = 0.001). Conclusion This is the first article benchmarking the incidence of SSI in neonatal surgery in the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were independent risk factors for SSI. More research is needed to develop strategies to reduce SSI in selected neonatal procedures.

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