Wound risk assessment in XXXX : generation and internal validation of  a risk stratification system using the ACS-NSQIP.

@entity1 @entity28 @entity281 @entity547 @entity35 @entity4037
BACKGROUND: There is a need for validated risk models to better stratify surgical site occurrences (SSO) following open @entity4037 (OVHR). The addition of more generalizable and validated risk models will serve to improve perioperative care in OVHR @entity1 . METHODS: We reviewed the 2005-2011 ACS-NSQIP databases identifying encounters for OVHR. The dependent outcome measure of interest was SSO, defined as superficial surgical site infection, @entity281 , or wound dehiscence. Multivariate logistic regression of independently associated factors was performed and internally validated using a bootstrap technique. A composite risk score, the Hernia Wound Risk Assessment Tool (HW- @entity35 ) was created using weighted beta coefficients. The HW- @entity35 was compared to existing models from the literature. RESULTS: A total of 60,187 @entity1 who met inclusion criteria were identified in the 2005-2011 ACS-NSQIP databases. The incidence of SSO in the study was 6.2  % (N  =  3,732). SSO risk factors were broken down based on rounded risk scores into the following groups: mild, intermediate, moderate, and severe risk. Severe risk factors related to operative time and degree of wound contamination. Moderate risk factors included @entity28 , component separation, dependent functional status, and inpatient @entity547 surgery. @entity1 stratification was performed based on total risk score into HW- @entity35 risk groups 1 through 5 which demonstrated significant discrimination between and across each group (P  <  0.01, C-statistic  =  0.71) with an incidence of SSO that ranged from 3.3 to 26.5  %. CONCLUSION: We present an internally validated risk model of SSO in OVHR (HW- @entity35 ), which complements and builds upon current risk models. LEVEL OF EVIDENCE: Prognostic/risk category, level II.
