Performance of surgical site infection risk prediction models in colorectal surgery: external validity assessment from three European national surveillance networks.

OBJECTIVE: To assess the validity of multivariable models for predicting risk of surgical site infection (SSI) after colorectal surgery based on routinely collected data in national surveillance networks. DESIGN: Retrospective analysis performed on 3 validation cohorts. PATIENTS: Colorectal surgery patients in Switzerland, France, and England, 2007-2017. METHODS: We determined calibration and discrimination (ie, area under the curve, AUC) of the COLA (contamination class, obesity, laparoscopy, American Society of Anesthesiologists [ASA]) multivariable risk model and the National Healthcare Safety Network (NHSN) multivariable risk model in each cohort. A new score was constructed based on multivariable analysis of the Swiss cohort following colorectal surgery, then based on colon and rectal surgery separately. RESULTS: We included 40,813 patients who had undergone elective or emergency colorectal surgery to validate the COLA score, 45,216 patients to validate the NHSN colon and rectal surgery risk models, and 46,320 patients in the construction of a new predictive model. The COLA score's predictive ability was poor, with AUC values of 0.64 (95% confidence interval [CI], 0.63-0.65), 0.62 (95% CI, 0.58-0.67), 0.60 (95% CI, 0.58-0.61) in the Swiss, French, and English cohorts, respectively. The NHSN colon-specific model (AUC, 0.61; 95% CI, 0.61-0.62) and the rectal surgery-specific model (AUC, 0.57; 95% CI, 0.53-0.61) showed limited predictive ability. The new predictive score showed poor predictive accuracy for colorectal surgery overall (AUC, 0.65; 95% CI, 0.64-0.66), for colon surgery (AUC, 0.65; 95% CI, 0.65-0.66), and for rectal surgery (AUC, 0.63; 95% CI, 0.60-0.66). CONCLUSION: Models based on routinely collected data in SSI surveillance networks poorly predict individual risk of SSI following colorectal surgery. Further models that include other more predictive variables could be developed and validated.

Surgical site infection after trans urethral resection of the prostate (TURP): 2008-2013 French national SSI surveillance ISO-RAISIN.

OBJECTIVE: To describe surgical site infection (SSI) after transurethral resection of prostate (TURP) from the French national database. METHODS: A national SSI surveillance system was implemented in 1999. Each year, the network included urology departments that included at least two months plus one month follow-up, or at least 100 consecutive targeted surgical procedures. A dataset of patients who underwent urology procedures during the six-year period 2008-2013 was made available. SSI diagnosis was made according to standardised CDC criteria. Descriptive analyses were performed using SAS software version 9.4. RESULTS: A total of 12,897 TURPs were performed by 89 urology departments. The crude incidence SSI rate was 2.43 (95% confidence interval = 2.16-2.79). The mean delay for diagnosis was 11.9 ± 8.9 days. The treatment of the SSI required a new surgical intervention in 1.35%. In the multilevel multivariate analysis, ASA score and duration of follow-up were the only parameters correlated with the SSI rate. CONCLUSIONS: On more than 12,000 TURPs surveyed, the SSI rate was 2.43. ASA score and duration of follow-up were the only parameters correlated with the SSI rate.