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[Prognostic index in wound infection and abdominal sepsis]
A Chalita-Manzur1, J M Hermosillo-Sandoval
1Departamento de Cirugía General, Centro Médico Nacional de Occidente, Guadalajara, Jalisco, México.
Insights
A new Prognostic Index of Surgical Infections (PISI) accurately predicts abdominal surgical site infection risk. This index helps identify patients at high risk, enabling targeted preventative strategies for better surgical outcomes.
Area of Science:
- Surgical Infection Prevention
- Prognostic Index Development
- Abdominal Surgery Outcomes
Context:
- Abdominal surgery carries a baseline infection risk of 1%, escalating with factors like age, diabetes, obesity, and emergency procedures.
- Existing risk assessments may not comprehensively integrate all contributing factors for surgical site infections.
- Accurate prediction of surgical site infections is crucial for patient management and resource allocation.
Purpose:
- To develop and validate a comprehensive prognostic index for predicting abdominal surgical site infections.
- To identify and quantify the impact of various risk factors on postoperative infection development.
- To establish a reliable tool for assessing individual patient risk before and after abdominal surgery.
Summary:
- A study involving 199 patients developed the Prognostic Index of Surgical Infections (PISI) by aggregating multiple risk factors.
- PISI scores demonstrated a clear correlation with infection risk: scores ≤12 had 0% infection, while scores ≥22 had 100% risk.
- The index achieved 100% sensitivity and approximately 75% specificity in predicting surgical infections.
Impact:
- PISI offers a reliable, sensitive, and specific method for assessing abdominal surgical infection risk.
- The index can guide clinical decision-making, potentially reducing infection rates and improving patient outcomes.
- This tool aids in proactive patient care by identifying individuals requiring closer monitoring or specific interventions.
Objective:
To establish an abdominal surgical infection prognostic index with all risk factors.
Summary Background Data:
Individuals, requiring abdominal surgery have an established surgical infection risk of 1% and this risk increases with several factors, such as age over 50 years, (4%), diabetes mellitus (12%), obesity (8%), hospitalization up to 10 days (4%), bad nutrition (2%), surgical time up to 3 h (6%) summer (4%) shock (6%) immunosuppression (6%), contaminated surgery (from 1%-40%), or emergency surgery (4%).
Method:
We reviewed 199 patients and investigated previous disease, total white blood cells, oxygen saturation, albumin, body weight, type of surgery performed in regard to contamination, surgical time, hospitalization time, preoperative hair removal previous to surgery, presence of emergency surgery, and prevalence of remote site infections at time of surgery. All these parameters were reviewed for 48 h before and after the surgical procedure and every risk factor acquired a number with respect to the established risk in the world literature. An index called Prognostic index of surgical infections (PISI) was performed, made up of the addition of risk factors. Every patient was observed 10 days after the surgical procedure searching for abdominal or wound infection and correlating the index with the presence of surgical infection.
Results:
Patients with a prognostic index of 12 or less did not show infections in any case; those with an index of 13 to 15 points had 30% of risk infection, 16 to 18 obtained 70%, 19 to 21 acquired 90%, and 22 or more obtained 100% of surgical risk infection. Sensitivity was 100% and specificity, nearby 75%.
Conclusions:
PISI is a reliable indicator of surgical infection risk because it takes into account all factors that cause troubles in the patients, and has high sensitivity and very good specificity.