NNIS risk score or COLA score: which predicts better the risk of surgical site infection among patients undergoing colorectal resection in a tertiary care hospital setting?
DOI:
https://doi.org/10.18203/2349-2902.isj20223163Keywords:
COLA score colorectal surgery, Risk prediction, Surgical site infectionAbstract
Background: By using predictive scores to identify and quantify risk of Surgical site infections (SSI), preventive measures can be directed effectively to improve patient outcome post operatively. This study was undertaken to compare the National Nosocomial Infections Surveillance (NNIS) risk index and COLA (contamination, obesity, laparotomy and ASA grade) scores to predict risk of SSI among patients undergoing colorectal resection.
Methods: A total of 77 patients who underwent colorectal resection at a tertiary care hospital were enrolled in this study. Wound surveillance was performed in all patients during the hospital stay and follow-up information for 30 days postoperatively was collected. Data analysis was done in SPSS version 20.0 for windows. Descriptive analysis was used to exhibit the clinical parameters. Differences between groups were tested by Pearson chi-square and fisher’s exact test. ROC curves were utilized. All the statistical tests were examined with 5% (p≤0.05) level of significance.
Results: Incidence of overall SSI was 28.6%. Superficial SSI was more common (14.3%). Serious organ/deep space infection occurred only in 9.1%. Area under the curve (AUC) for NNIS score was 0.645 (95% CI: 0.510-0.781, p<0.05) and 0.611 for the COLA score. (95% CI: 0.472-0.750, p>0.05). Therefore, both these scores have less than acceptable accuracy in this data set to predict SSI.
Conclusions: The risk prediction models (NNIS, COLA) although simple, did not accurately predict the risk of SSI in the given study population.
References
Paulson EC, Thompson E, Mahmoud N. Surgical site infection and colorectal surgical procedures: a prospective analysis of risk factors. Surg Infect. 2017;18(4):520-6.
Ju MH, Ko CY, Hall BL, Bosk CL, Bilimoria KY, Wick EC. A Comparison of 2 Surgical Site Infection Monitoring Systems. JAMA Surg. 2015;150(1):51-7.
Drosdeck J, Harzman A, Suzo A, Arnold M, Abdel-rasoul M, Husain S. Multivariate analysis of risk factors for surgical site infection after laparoscopic colorectal surgery. Surg Endosc. 2013;27(12):4574-80.
Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S-7S.
Gervaz P, Bandiera-Clerc C, Buchs NC, Eisenring MC, Troillet N, Perneger T, et al. Scoring system to predict the risk of surgical-site infection after colorectal resection. Br J Surg. 2012;99(4):589-95.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5):309-32.
Townsend JC, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery: the Biological Basis of Modern Surgical Practice. 21st ed. Netherlands: Elsevier Inc; 2022:11;224-5.
Misra A. Ethnic-specific criteria for classification of body mass index: a perspective for Asian Indians and American diabetes association position statement. Diabetes Technol Ther. 2015;17(9):667-71.
Doyle DJ, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). Treasure Island (FL): StatPearls Publishing; 2018.
Saylam B, Tez M, Comcali B. Validation of COLA score for predicting wound infection in patients undergoing surgery for rectal cancer. Ann Ital Chir. 2017;88:514-8.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.
Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-27.
Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kübler A, Viet-Hung N, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005-2010. Infect Control Hosp Epidemiol. 2013;34(6):597-604.
Singh S, Chakravarthy M, Rosenthal VD, Myatra SN, Dwivedy A, Bagasrawala I, et al. Surgical site infection rates in six cities of India: findings of the International Nosocomial Infection Control Consortium (INICC). Int Health. 2015;7(5):354-9.
Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103(1): 89-95.
Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, et al. Wound infection after elective colorectal resection. Ann Surg. 2004; 239(5):599-605.
Nespoli A, Gianotti L, Totis M, Bovo G, Nespoli L, Chiodini P, et al. Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumori. 2004;90(5):485-90.
Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1-15.
Eagye KJ, Nicolau DP. Deep and organ/space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs. Am J Surg. 2009;198(3):359-67.
Scott RD. The Direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Available at: http://www.cdc. gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed on 20 November 2021.
Sarah J, Surbhi L, Michael AP, Harris-Williams M, Thom K. Factors for surgical site infection following colorectal surgery, open forum infectious diseases. Am J Surg. 2016;3(1):1152-5.
Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33 (2):S69-77.
Watanabe M, Suzuki H, Nomura S, Hanawa H, Chihara N, Mizutani S, et al. Performance assessment of the risk index category for surgical site infection after colorectal surgery. Surg Infect. 2015;16(1):84-9.
Public Health England. Surgical Site Infections (SSI) Surveillance: NHS Hospitals in England 2014/15. Available at: https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/484874/Surveillance_of_Surgical_Site_Infections_in_NHS_Hospitals_in_England_report_2014-15.pdf. Accessed on 20 November 2021.
Kurmann A, Vorburger SA, Candinas D, Beldi G. Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc. 2011;25(11):3531-4.
Gurunathan U, Ramsay S, Mitrić G, Way M, Wockner L, Myles P. Association between obesity and wound infection following colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg. 2017;21(10):1700-12.
Bergquist JR, Thiels CA, Etzioni DA, Habermann EB, Cima RR. Failure of colorectal surgical site infection predictive models applied to an independent dataset: do they add value or just confusion? J Am Coll Surg. 2016;222(4):431-8.
Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thoracic Oncol. 2010;5(9):1315-6.