Risk factors for surgical site infections using a data-driven approach

• Published in: PloS one 2020-10, Vol.15 (10), p.e0240995-e0240995
• Main Authors: van Niekerk, J M, Vos, M C, Stein, A, Braakman-Jansen, L M A, Voor In 't Holt, A F, van Gemert-Pijnen, J E W C
• Format: Article
• Language: English
• Subjects: Adolescent; Algorithms; Antibiotics; Biology and Life Sciences; C-reactive protein; Data mining; Digestive system; Disease management; Female; Health risk assessment; Health risks; Humans; Infections; Infectious diseases; Information science; Male; Medical research; Medicine and Health Sciences; Methods; Nosocomial infections; Orthopedic Procedures - adverse effects; Orthopedics; Physical Sciences; Regression analysis; Regression models; Research and Analysis Methods; Retrospective Studies; Risk analysis; Risk Factors; Surgery; Surgical site infections; Surgical Wound Infection - etiology; Surgical wound infections; Technology application; Temperature; Thoracic surgery; Thorax; Variables; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240995

The objective of this study was to identify risk factors for surgical site infection from digestive, thoracic and orthopaedic system surgeries using clinical and data-driven cut-off values. A second objective was to compare the identified risk factors in this study to risk factors identified in literature. Retrospective data of 3 250 surgical procedures performed in large tertiary care hospital in The Netherlands during January 2013 to June 2014 were used. Potential risk factors were identified using a literature scan and univariate analysis. A multivariate forward-step logistic regression model was used to identify risk factors. Standard medical cut-off values were compared with cut-offs determined from the data. For digestive, orthopaedic and thoracic system surgical procedures, the risk factors identified were preoperative temperature of ≥38°C and antibiotics used at the time of surgery. C-reactive protein and the duration of the surgery were identified as a risk factors for digestive surgical procedures. Being an adult (age ≥18) was identified as a protective effect for thoracic surgical procedures. Data-driven cut-off values were identified for temperature, age and CRP which can explain the SSI outcome up to 19.5% better than generic cut-off values. This study identified risk factors for digestive, orthopaedic and thoracic system surgical procedures and illustrated how data-driven cut-offs can add value in the process. Future studies should investigate if data-driven cut-offs can add value to explain the outcome being modelled and not solely rely on standard medical cut-off values to identify risk factors.