Prognostic models for surgical-site infection in gastrointestinal surgery: systematic review

Kenneth a Mclean*, Tanvi Goel, Samuel Lawday, Aya Riad, Joana Simoes, Stephen r Knight, Dhruva Ghosh, James c Glasbey, Aneel Bhangu, Ewen m Harrison, NIHR Global Health Research Unit on Global Surgery

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background:
Identification of patients at high risk of surgical-site infection may allow clinicians to target interventions and monitoring to minimize associated morbidity. The aim of this systematic review was to identify and evaluate prognostic tools for the prediction of surgical-site infection in gastrointestinal surgery.

Methods:
This systematic review sought to identify original studies describing the development and validation of prognostic models for 30-day SSI after gastrointestinal surgery (PROSPERO: CRD42022311019). MEDLINE, Embase, Global Health, and IEEE Xplore were searched from 1 January 2000 to 24 February 2022. Studies were excluded if prognostic models included postoperative parameters or were procedure specific. A narrative synthesis was performed, with sample-size sufficiency, discriminative ability (area under the receiver operating characteristic curve), and prognostic accuracy compared.

Results:
Of 2249 records reviewed, 23 eligible prognostic models were identified. A total of 13 (57 per cent) reported no internal validation and only 4 (17 per cent) had undergone external validation. Most identified operative contamination (57 per cent, 13 of 23) and duration (52 per cent, 12 of 23) as important predictors; however, there remained substantial heterogeneity in other predictors identified (range 2–28). All models demonstrated a high risk of bias due to the analytic approach, with overall low applicability to an undifferentiated gastrointestinal surgical population. Model discrimination was reported in most studies (83 per cent, 19 of 23); however, calibration (22 per cent, 5 of 23) and prognostic accuracy (17 per cent, 4 of 23) were infrequently assessed. Of externally validated models (of which there were four), none displayed ‘good’ discrimination (area under the receiver operating characteristic curve greater than or equal to 0.7).

Conclusion:
The risk of surgical-site infection after gastrointestinal surgery is insufficiently described by existing risk-prediction tools, which are not suitable for routine use. Novel risk-stratification tools are required to target perioperative interventions and mitigate modifiable risk factors.
Original languageEnglish
Article numberznad187
Pages (from-to)1441-1450
Number of pages10
JournalBritish Journal of Surgery
Volume110
Issue number11
Early online date12 Jul 2023
DOIs
Publication statusPublished - 1 Nov 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2023.

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