Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 89
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Barrett, Christopher D. Celestin, Arthur Fish, Emily Glass, Charity C. Eskander, Mariam F. Murillo, Rudy Gospodinov, Georgi Gupta, Alok and Hauser, Carl J. 2016. Surgical wound assessment by sonography in the prediction of surgical wound infections. Journal of Trauma and Acute Care Surgery, Vol. 80, Issue. 2, p. 229.

    Chow, Christopher J. Hayes, Lisa M. and Saltzman, Daniel A. 2016. The impact of perioperative warm-up jackets on surgical site infection: cost without benefit?. The American Journal of Surgery,

    Endo, Shunji Tsujinaka, Toshimasa Fujitani, Kazumasa Fujita, Junya Tamura, Shigeyuki Yamasaki, Makoto Kobayashi, Shogo Akamaru, Yusuke Mizushima, Tsunekazu Shimizu, Junzo Umeshita, Koji Ito, Toshinori Mori, Masaki and Doki, Yuichiro 2016. Risk factors for superficial incisional surgical site infection after gastrectomy: analysis of patients enrolled in a prospective randomized trial comparing skin closure methods. Gastric Cancer, Vol. 19, Issue. 2, p. 639.

    Esser, Jennifer Shrinski, Keonemana Cady, Rhonda and Belew, John 2016. Reducing OR Traffic Using Education, Policy Development, and Communication Technology. AORN Journal, Vol. 103, Issue. 1, p. 82.

    Fry, Donald E. 2016. Infection control in colon surgery. Langenbeck's Archives of Surgery, Vol. 401, Issue. 5, p. 581.

    Fukuda, H. 2016. Patient-related risk factors for surgical site infection following eight types of gastrointestinal surgery. Journal of Hospital Infection, Vol. 93, Issue. 4, p. 347.

    Leekha, Surbhi Lahr, Brian D. Thompson, Rodney L. Sampathkumar, Priya Duncan, Audra A. and Orenstein, Robert 2016. Preoperative risk prediction of surgical site infection requiring hospitalization or reoperation in patients undergoing vascular surgery. Journal of Vascular Surgery, Vol. 64, Issue. 1, p. 177.

    Manning, David W. Edelstein, Adam I. and Alvi, Hasham M. 2016. Risk Prediction Tools for Hip and Knee Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, Vol. 24, Issue. 1, p. 19.

    Morgan, Daniel M. Swenson, Carolyn W. Streifel, Kristin M. Kamdar, Neil S. Uppal, Shitanshu Burgunder-Zdravkovski, Lorraine Pearlman, Mark D. Fenner, Dee E. and Campbell, Darrell A. 2016. Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative. American Journal of Obstetrics and Gynecology, Vol. 214, Issue. 2, p. 259.e1.

    Muratore, Sydne Statz, Catherine Glover, J.J. Kwaan, Mary and Beilman, Greg 2016. Risk Adjustment for Determining Surgical Site Infection in Colon Surgery: Are All Models Created Equal?. Surgical Infections, Vol. 17, Issue. 2, p. 173.

    Murray, Alice Charlotte Adelaide Pasam, Ravi Estrada, David and Kiran, Ravi P. 2016. Risk of Surgical Site Infection Varies Based on Location of Disease and Segment of Colorectal Resection for Cancer. Diseases of the Colon & Rectum, Vol. 59, Issue. 6, p. 493.

    Pedroso-Fernandez, Yanet Aguirre-Jaime, Armando Ramos, Maria J. Hernández, Miriam Cuervo, Milagros Bravo, Alberto and Carrillo, Angel 2016. Prediction of surgical site infection after colorectal surgery. American Journal of Infection Control, Vol. 44, Issue. 4, p. 450.

    Prasad, P A Wong-McLoughlin, J Patel, S Coffin, S E Zaoutis, T E Perlman, J DeLaMora, P Alba, L Ferng, Y-h and Saiman, L 2016. Surgical site infections in a longitudinal cohort of neonatal intensive care unit patients. Journal of Perinatology, Vol. 36, Issue. 4, p. 300.

    Różańska, Anna Wójkowska-Mach, Jadwiga Bulanda, Małgorzata and Heczko, Piotr B. 2016. Surgical patients’ safety in Polish hospital environment in the context of selected infection control practices. Journal of Patient Safety & Infection Control,

    Weiner, Lindsey M. Fridkin, Scott K. Aponte-Torres, Zuleika Avery, Lacey Coffin, Nicole Dudeck, Margaret A. Edwards, Jonathan R. Jernigan, John A. Konnor, Rebecca Soe, Minn M. Peterson, Kelly and McDonald, L. Clifford 2016. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014. MMWR. Morbidity and Mortality Weekly Report, Vol. 65, Issue. 9, p. 235.

    Weiner, Lindsey M. Fridkin, Scott K. Aponte-Torres, Zuleika Avery, Lacey Coffin, Nicole Dudeck, Margaret A. Edwards, Jonathan R. Jernigan, John A. Konnor, Rebecca Soe, Minn M. Peterson, Kelly and McDonald, L. Clifford 2016. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014. American Journal of Transplantation, Vol. 16, Issue. 7, p. 2224.

    Weiner, Lindsey M. Fridkin, Scott K. Aponte-Torres, Zuleika Avery, Lacey Coffin, Nicole Dudeck, Margaret A. Edwards, Jonathan R. Jernigan, John A. Konnor, Rebecca Soe, Minn M. Peterson, Kelly and McDonald, L. Clifford 2016. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014. MMWR. Morbidity and Mortality Weekly Report, Vol. 65, Issue. 9,

    Woelber, Erik Schrick, Emily J. Gessner, Bradford D. and Evans, Heather L. 2016. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surgical Infections,

    Yu, Anthony L. Alfieri, David C. Bartucci, Kristen N. Holzmeister, Adam M. and Rees, Harold W. 2016. Wound Hygiene Practices After Total Knee Arthroplasty: Does It Matter?. The Journal of Arthroplasty,

    Agodi, Antonella Quattrocchi, Annalisa Barchitta, Martina Adornetto, Veronica Cocuzza, Aldo Latino, Rosalia Destri, Giovanni Li and Di Cataldo, Antonio 2015. Risk of Surgical Site Infection in Older Patients in a Cohort Survey: Targets for Quality Improvement in Antibiotic Prophylaxis. International Surgery, Vol. 100, Issue. 3, p. 473.

  • Infection Control & Hospital Epidemiology, Volume 32, Issue 10
  • October 2011, pp. 970-986

Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safely Network

  • Yi Mu (a1), Jonathan R. Edwards (a1), Teresa C. Horan (a1), Sandra I. Berrios-Torres (a1) and Scott K. Fridkin (a1)
  • DOI:
  • Published online: 02 January 2015

The National Healthcare Safety Network (NHSN) has provided simple risk adjustment of surgical site infection (SSI) rates to participating hospitals to facilitate quality improvement activities; improved risk models were developed and evaluated.


Data reported to the NHSN for all operative procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Only SSIs related to the primary incision site were included. A common set of patient- and hospital-specific variables were evaluated as potential SSI risk factors by univariate analysis. Some ific variables were available for inclusion. Stepwise logistic regression was used to develop the specific risk models by procedure category. Bootstrap resampling was used to validate the models, and the c-index was used to compare the predictive power of new procedure-specific risk models with that of the models with the NHSN risk index as the only variable (NHSN risk index model).


From January 1, 2006, through December 31, 2008, 847 hospitals in 43 states reported a total of 849,659 procedures and 16,147 primary incisional SSIs (risk, 1.90%) among 39 operative procedure categories. Overall, the median c-index of the new procedure-specific risk was greater (0.67 [range, 0.59–0.85]) than the median c-index of the NHSN risk index models (0.60 [range, 0.51–0.77]); for 33 of 39 procedures, the new procedure-specific models yielded a higher c-index than did the NHSN risk index models.


A set of new risk models developed using existing data elements collected through the NHSN improves predictive performance, compared with the traditional NHSN risk index stratification.

Corresponding author
1600 Clifton Road NE MS A-24, Atlanta, GA 30329-4018 (
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

5.R Gaynes , C Richards , JR Edwards , et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295298.

6.C Brandt , S Hansen , D Sohr , F Daschner , H Ruden , P Gastmeier . Finding a method for optimizing risk adjustment when comparing surgical-site infecions rates. Infect Control Hosp Epidemiol 2004;25:1318.

8.DH Culver , TC Horan , RP Gaynes , et al. Surgical wound-infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91:S152S157.

12.DM Shahian , SM O'Brien , G Filardo , VA Ferraris , CK Haan , JB Rich , et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Ann Thome Surg 2009;88:S2S22.

14.M Paul , A Raz , L Leibovici , H Madar , R Holinger , B Rubinovitch . Sternal wound infection after coronary artery bypass graft surgery: validation of existing risk scores. J Thorac Cardiovasc Surg 2007;133:397403.

16.JR Edwards , KD Peterson , Y Mu , et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37: 783805.

20.JA Hanley , BJ McNeil . The meaning and use of the area under a receive operating characteristic (ROC) curve. Radiology 1982; 143:2936.

21.JA Hanley , BJ McNeil . A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839843.

22.CS Abboud , SB Wey , VT Baltar . Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 2004;77:676683.

24.RP Gaynes . Surgical-site infections (SSI) and the NNIS SSI risk index, part II: room for improvement. Infect Control Hosp Epidemiol 2001;22:268272.

28.M Kivi , J Mannien , JC Wille , S van den Hof . Surgical site infection surveillance and the predictive power of the National Nosocomial Infection Surveillance index as compared with alternative determinants in the Netherlands. Am J Infect Control 2008;36:S27S31.

29.L Neumayer , P Hosokawa , K Itani , M El-Tamer , WG Henderson , SF Khuri . Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204: 11781187.

30.MA Olsen , P Lock-Buckley , D Hopkins , LB Polish , TM Sundt , VJ Fraser . The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002;124:136145.

32.TS Tran , S Jamulitrat , V Chongsurvivatwong , A Geater . Risk factors for postcesarean surgical site infection. Obstet Gynecol 2000;95:367371.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *