Risk Factor |
Evidence |
Mod? |
Pat. |
Periop |
Surg. |
EMR |
Define |
IH |
Denver DSS, MANUAL FROM EDM, ICP, UNAVAILABLE |
Vail DSS, MANUAL FROM EDM, ICP, UNAVAILABLE |
PRESENT AT SLC VA |
Common w/ VA |
Common Elements |
Age |
|
N |
Y |
|
|
1 |
|
Y = EMR |
D = EMR |
Electronic = EMR |
1 |
Y |
Y |
Gender |
|
N |
Y |
|
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Body Mass Index |
II |
N |
Y |
|
|
1 |
|
Y |
LL = found in LifeLink only |
Electronic |
NSQIP |
NSQIP |
Y |
Comorbidity Score (Charlson or whatever is available) |
|
N |
Y |
|
|
1 |
|
Y |
?? |
?? |
1 |
|
|
Diabetes |
II |
N |
Y |
|
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Chronic Lung Disease |
|
N |
Y |
|
|
|
1 |
depends on definition |
D |
Electronic |
1 |
Y |
Y |
Chronic Kidney Disease |
|
N |
Y |
|
|
|
1 |
depends on definition |
D |
Electronic |
1 |
Y |
Y |
Peripheral vascular disease |
|
N |
Y |
|
|
|
1 |
depends on definition |
D |
Electronic |
1 |
|
Y |
Prior site irradiation (At any time) |
|
N |
Y |
|
|
|
1 |
Y |
M |
Manual |
NSQIP - w/in 90d |
|
|
Recent operation (Within 30 days) |
|
N |
Y |
|
|
|
Time window? |
Y |
D |
Manual |
1 |
|
|
Skin carriage of staphylococci |
|
N |
Y |
|
|
|
1 |
chart review |
D if in micro |
Electronic (if done in our lab) |
1 |
|
|
Skin disease in the area of surgery (eg, psoriasis) |
|
N |
Y |
|
|
? |
|
chart review |
M |
Manual |
Skin dis, but not localization |
|
|
Wound Class |
I |
N |
Y |
|
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Emergent Procedure |
|
N |
Y |
|
|
1 |
|
Y |
D |
Electronic |
NSQIP |
NSQIP |
Y |
ASA Score |
I |
N |
Y |
|
|
1 |
|
at 3 hospitals |
M |
Electronic |
1 |
|
|
Revision/Re-do Operation |
|
N |
Y |
|
|
|
1 |
ICD-9 codes, laterality unknown |
D is use ORSOS codes |
Electronic |
1 |
|
|
Pre-Op Hospitalization (# of days) |
|
N |
Y |
|
|
|
Time window? |
surgery start time - admission time |
D |
Electronic |
1 |
Y |
Y |
Hx of MRSA |
|
N |
Y |
|
|
1 |
< 5 years? |
Y |
D |
Electronic |
1 |
Y |
Y |
Homelessness |
|
N |
Y |
|
|
? |
|
N |
D |
Manual |
0 |
|
|
Hospitalizations in Prior 12 Months (#) |
|
N |
Y |
|
|
1 |
|
system hospitalizations only |
D |
Manual (if at VVMC or mentioned in H&P) |
1 |
|
|
Surgical Site |
|
N |
Y |
|
|
1 |
|
laterality unknown |
D |
ICP |
1 |
|
|
Insurance/Payor Source |
|
N |
Y |
|
|
1 |
1 |
Y |
D |
Electronic |
check with Pat |
|
Y |
Hx Rheumatologic Disease |
|
N |
Y |
|
|
|
1 |
Y |
D |
Electronic |
1 |
Y |
Y |
Previous Surgical Site Infection |
|
N |
Y |
|
|
1 |
|
just last year for most hospitals |
D |
ICP |
1 |
|
|
Instututionalized |
|
N |
Y |
|
|
|
1 |
system institutionalizations only |
D |
Manual (if in H&P) |
? |
|
|
NNIS Risk Index |
I |
N |
Y |
|
|
|
1 |
don't know |
I ?? |
ICP |
1 |
|
|
Glucose Control (Hgb A1C and Pre-op Glucose) |
|
Y |
Y |
|
|
|
1 |
Y |
D |
Not sure what you're looking for |
1 |
|
|
Hypocholesterolemia |
|
Y |
Y |
|
|
|
1 |
Y |
D |
Electronic |
1 |
Y |
Y |
Preoperative anemia (recorded as hemoglobin level) |
|
Y |
Y |
|
|
|
1 |
have times of surgery and times of HCT |
D |
Electronic |
1 |
Y |
Y |
Postoperative anemia (recorded as hemoglobin level) |
|
Y |
Y |
|
|
|
1 |
have times of surgery and times of HCT |
D |
Electronic |
1 |
Y |
Y |
Remote infection |
|
Y |
Y |
|
|
|
1 |
define? |
?? |
ICP |
1 |
|
|
Malnutrition (Wt loss, albumin, prealbumin) |
|
Y |
Y |
|
|
|
1 |
N |
?? |
If albumin is drawn - Electronic |
albumin, etc |
|
|
Smoking |
|
Y |
Y |
|
|
1 |
|
some positives |
LL |
Electronic |
w/in 1 year in NSQIP |
|
|
Alcohol Abuse |
|
Y |
Y |
|
|
|
1 |
some positives |
D |
Electronic |
NSQIP |
NSQIP |
Y |
Substance Abuse |
|
Y |
Y |
|
|
|
1 |
some positives |
D |
Electronic |
0 |
|
Y |
Staph Aureus Colonization |
|
Y |
Y |
|
|
1 |
|
what Scott says |
?? |
Electronic (if done in our lab) |
1 |
|
|
Preoperative Shower |
|
Y |
Y |
|
|
? |
|
chart review |
?? |
Electronic |
? |
|
|
Immunosuppressive Drugs Pre-Op |
|
Y |
Y |
|
|
1 |
Need med list |
chart review |
M |
Manual |
1 |
|
|
Pre-Op Albumin Level |
|
|
Y |
|
|
1 |
1 |
time of surgery and time of blood draw |
D |
Electronic |
1 |
Y |
Y |
Ascites |
|
|
Y |
|
|
|
1 |
abdominal |
M or LL |
Manual |
NSQIP - w/in 30d |
|
|
Chronic inflammation |
|
|
Y |
|
|
|
1 |
define? |
M or D |
Manual |
if CRP, ESR then yes |
|
|
Corticosteroid therapy w/in 30 Days |
|
|
Y |
|
|
1 |
need med list |
if in system |
M or D |
Manual |
1 |
|
|
Duration of Surgery (min) |
|
N |
|
Y |
|
1 |
|
Y |
D |
Electronic |
1 |
|
Y |
Tourniquet Time |
|
N |
|
Y |
|
? |
|
don't know |
M ?? |
Manual |
0 |
|
|
Post-Op Mechanical Ventilation |
|
N |
|
Y |
|
1 |
|
chart review |
D |
Manual |
NSQIP for >48h |
|
|
Surgeon Experience (# Past 12 Months) |
|
N |
|
|
Y |
1 |
Define |
Y |
D |
Electronic |
1 |
Y |
Y |
Surgeon Age |
|
N |
|
|
Y |
? |
|
Y |
D |
Manual |
0 |
|
|
Laparoscopic Approach |
I |
Y |
|
Y |
|
1 |
|
chart review prior to Oct 2008 |
D |
Electronic |
if indicated by code |
|
|
General Anesthesia |
|
Y |
|
Y |
|
1 |
|
intra-op drugs on paper anesthesia record |
D |
Electronic |
1 |
Y |
Y |
No. of Personnel in OR |
|
Y |
|
Y |
|
? |
|
Y |
D |
Manual |
1 |
|
|
Trainee (Lowest Level) Scrubbed in OR |
|
Y |
|
Y |
|
? |
|
Y |
D (can u tell who is scrubbed in ORSOS) |
Manual |
1 |
|
|
OR Traffic |
|
Y |
|
Y |
|
? |
|
N |
U |
Unavailable |
0 |
|
|
Timely Pre-Op Abx |
I |
Y |
|
Y |
|
? |
|
chart review |
D (or M if core measures criteria) |
Electronic |
1 |
|
|
Appropriate Pre-op Abx |
II |
Y |
|
Y |
|
|
1 |
chart review |
D (or M if core measures criteria) |
Electronic |
1 |
|
|
Discontinuation of Post-Op Abx <24 hr |
III |
Y |
|
Y |
|
1 |
|
Y |
D (or M if core measures criteria) |
Electronic |
1 |
Y |
Y |
Appropriate Intra-Op Re-dosing of Abx |
|
Y |
|
Y |
|
no |
|
on paper anesthesia record |
D (or M if core measures criteria) |
Manual |
1 |
|
|
Lowest Intra-Op Temperature |
I |
Y |
|
Y |
|
? |
|
on paper anesthesia record |
M |
Manual |
not reliably |
|
|
Temperature on Arrival to PACU |
I |
Y |
|
Y |
|
? |
|
on paper anesthesia record |
M |
Electronic |
not reliably |
|
|
Peri-Op Glucose <100 |
|
Y |
|
Y |
|
1 |
|
Y |
M |
Electronic |
1 |
|
|
Peri-Op Glucose <200 |
|
Y |
|
Y |
|
1 |
|
Y |
M |
Electronic |
1 |
|
|
Peri-Op Transfusion |
II |
Y |
|
Y |
|
1 |
|
times on paper for intra-op transfusions |
M |
Electronic |
1 |
|
|
Skin Prep |
I |
Y |
|
Y |
|
? |
|
chart audit |
M |
Electronic |
0 |
|
|
Hair Removal |
II |
Y |
|
Y |
|
? |
|
chart audit |
M |
Electronic |
0 |
|
|
Abx Irrigation |
|
Y |
|
Y |
|
? |
|
chart audit |
D |
Electronic |
0 |
|
|
Injections into Wound (e.g., Local Anesthetic) |
|
Y |
|
Y |
|
? |
|
chart audit |
D |
Electronic |
0 |
|
|
Implant |
|
Y |
|
Y |
|
1 |
|
Y |
D |
Electronic |
1 |
|
|
Anesthetic Drugs |
|
Y |
|
Y |
|
? |
|
intra-op drugs on paper anesthesia record |
D |
Manual |
0 |
|
|
Outpatient Surgery |
|
Y |
|
Y |
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Inpatient Surgery |
|
Y |
|
Y |
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Post-Op Admit |
|
Y |
|
Y |
|
1 |
time window |
Y |
D |
Electronic |
1 |
Y |
Y |
Laminar Airflow OR |
|
Y |
|
Y |
|
1 |
|
facility assessment |
D |
All VVMC ORs are laminar |
? |
? |
Y |
HEPA Filtered OR |
|
Y |
|
Y |
|
? |
|
facility assessment |
D |
All VVMC ORs are laminar |
? |
? |
Y |
Number of Procedures (in same OR session) |
|
Y |
|
Y |
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Use of Drain |
|
Y |
|
Y |
|
? |
|
Y |
D |
Electronic |
? |
? |
Y |
ICU Admission Post-Op |
|
Y |
|
Y |
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Perioperative Hyperoxia (FiO2 80%) |
|
Y |
|
Y |
|
1 |
|
don't know |
LL |
Manual |
1 |
|
|
Peri-Op Insulin Administration |
|
Y |
|
Y |
|
|
1 |
intra-op drugs on paper anesthesia record |
D |
Electronic for pre-op/PACU, manual for OR |
1 |
|
|
Peri-Op Proton Pump Inhibitor |
|
Y |
|
Y |
|
|
1 |
intra-op drugs on paper anesthesia record |
D |
Electronic |
1 |
|
|
Peri-Op VTE Prophylaxis |
|
Y |
|
Y |
|
1 |
|
intra-op drugs on paper anesthesia record |
D |
Electronic |
1 |
|
|
Post-Op Wound Care by Nurse |
|
Y |
|
Y |
|
1 |
|
chart review |
LL |
Manual |
? |
|
|
Anticoagulation Medication |
|
Y |
|
Y |
|
1 |
|
intra-op drugs on paper anesthesia record |
D |
Electronic |
1 |
|
|
Post-Op Ambulation (What Day?) |
|
Y |
|
Y |
|
1 |
|
not reliable retrospectively |
LL |
Electronic |
? |
|
|
Liters of IV Fluid in OR |
|
Y |
|
Y |
|
? |
|
on paper anesthesia record |
M |
Electronic |
? |
|
|
Liters of Fluid 24 hrs Post-Op |
|
Y |
|
Y |
|
1 |
|
Y |
M |
Electronic |
1 |
|
|
Central Line |
|
Y |
|
Y |
|
1 |
|
Y |
D or M?? |
Electronic |
0 |
|
Y |
Pre-Op Hemoglobin (post-op was later added) |
|
Y |
|
|
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Use of Stryker Suit |
|
Y |
|
|
Y |
? |
|
Y |
?? |
Manual |
? |
|
|
Surgeon Beard |
|
Y |
|
|
Y |
? |
|
self-report |
?? |
Manual |
0 |
|
|
New/possible added by Scott |
|
|
|
|
|
|
|
|
|
|
|
|
|
Tissue expander use |
|
|
|
|
|
? |
|
Y |
D |
Electronic |
? |
? |
Y |
Daily living assistance needed |
|
|
|
|
|
? |
|
N |
M |
Manual/?? Electronic |
? |
|
|
Excessive blood loss; > 1 liter |
|
|
|
|
|
? |
|
OR chart review |
M |
Manual |
1 |
|
|
Suture material (Deep, and in wound) |
|
|
|
|
|
? |
|
OR chart review |
D |
Electronic |
? |
|
|
Incision method |
|
|
|
|
|
? |
|
OR chart review |
M |
Manual |
0 |
|
|
Frequency of glove change |
|
|
|
|
|
? |
|
N |
U |
Unavailable |
0 |
|
|
Subcutaneous hematoma |
|
|
|
|
|
? |
|
can't identify subcutaneous |
D if ICD9 or M |
Manual |
0 |
|
|
Hx of cancer |
|
|
|
|
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Periop allogeneic blood transfusion |
|
|
|
|
|
1 |
|
OR chart review, allogenic status iffy |
M for periop |
Electronic |
1 |
|
|
Interop vasopressor |
|
|
|
|
|
? |
|
paper anesthesia record |
D |
Manual |
1 |
|
|
Preop mechanical ventilation |
|
|
|
|
|
1 |
|
chart audit |
LL |
Electronic |
? |
|
|
Hx of abx allergy |
|
|
|
|
|
1 |
|
Y |
LL |
Electronic |
I think so |
? |
Y |
Preop urinary catheterization |
|
|
|
|
|
1 |
|
chart review |
LL |
Electronic |
0 |
|
|
Skin closure method |
|
|
|
|
|
? |
|
OR record chart review |
M |
Manual |
0 |
|
|
Periop lapse in discipline? |
|
|
|
|
|
? |
|
define? |
?? |
Unavailable/maybe in H&P |
0 |
|
|
Transfer from another hospital |
|
|
|
|
|
1 |
|
Y |
D |
Manual |
1 |
|
|
Tumor necrosis factor blockers |
|
|
|
|
|
1 |
|
N |
D |
Electronic |
1 |
|
|
Development of DVT |
|
|
|
|
|
1 |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Intraop inspired O2 < 50% |
|
|
|
|
|
? |
|
paper anesthesia record |
M |
Manual |
0 |
|
|
Duration of hypothermia; < 35.5 |
|
|
|
|
|
? |
|
paper anesthesia record |
D for approx. time |
Manual |
0 |
|
|
Tracheotomy |
|
|
|
|
|
1 |
|
Y |
D |
Electronic/?? Manual |
1 |
|
|
Bowel or bladder dysfunction |
|
|
|
|
|
? |
|
define? |
D |
Electronic |
? |
? |
Y |
No. of surgeons scrubbed |
|
|
|
|
|
? |
|
Y |
D |
Electronic |
? |
? |
Y |
Hx of COPD |
|
|
|
|
|
? |
|
Y |
D |
Electronic |
1 |
Y |
Y |
Total |
|
|
|
|
|
|
|
44 |
|
|
|
25 |
40 |
36 risk factors in the final list |
|
|
|
|
|
|
|
|
|
|
|
11 ? or NSQIP |
|