Appendix M. Master Risk Factor List with Final Bolded

Factor included in the final list of risk factors are bolded Diagnoses and conditions are defined by ICD-9 codes

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

Note:
The following factors were included in the final list of risk factors for identification and stratification purposes.

• Source of Admission
• Patient ID (random number with system prefix identifier
• SSI as a result of this surgery
• Surgery date/time
• Surgical Procedure (TH, TK, CA, HE)

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