Development and external validation of the ‘Global Surgical-Site Infection’ (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery
Author:
, KA McLean, SR Knight, N Clark, A Ademuyiwa, A Adisa, M Aguilera-Arevalo, D Ghosh, PD Haque, I Lawani, A Ramos-De la Medina, F Ntirenganya, S Samuel, S Tabiri, JF Simões, CA Shaw, SK Kamarajah, M Picciochi, R Pius, T Pinkney, E Li, D Morton, D Nepogodiev, JC Glasbey, A Bhangu, EM Harrison, AO Ademuyiwa, AO Adisa, ML Aguilera, A Altamini, P Alexander, SW Al-Saqqa, G Borda-Luque, J Cornick, A Costas-Chavarri, TM Drake, SJ Fergusson, JE Fitzgerald, J Glasbey, JA Ingabire, L Ismaïl, Z Jaffry, HK Salem, C Khatri, A Kirby, ATT Kojo, MC Lapitan, R Lilford, AL Mihaljevic, M Mohan, D Morton, AZ Mutabazi, D Nepogodiev, F Ntirenganya, R Ots, F Pata, T Pinkney, T Poškus, AU Qureshi, A Ramos-De la Medina, S Rayne, G Recinos, K Søreide, CA Shaw, S Shu, R Spence, N Smart, S Tabiri, EM Harrison, A Bhangu, A Verjee, E Runigamugabo, THA Ali, S Rekhis, M Rommaneh, O Halhouli, ZH Sam, L Ismaïl, V Kalles, F Pata, GE Nita, F Coccolini, L Ansaloni, TB Pugliesi, R Blanco, N Gobin, AV Freitas, N Hall, S Kim, A Negida, H Khairy, Z Jaffry, SJ Chapman, AP Arnaud, S Tabiri, G Recinos, Cutting Edge Manipal, M Mohan, R Amandito, M Shawki, M Hanrahan, F Pata, C Khatri, J Zilinskas, AC Roslani, CC Goh, AO Ademuyiwa, G Irwin, S Shu, L Luque, H Shiwani, A Altamimi, SJ Fergusson, R Spence, S Rayne, J Jeyakumar, Y Cengiz, DA Raptis, JC Glasbey, MM Modolo, D Iyer, S King, T Arthur, SN Nahar, A Waterman, L Ismaïl, M Walsh, A Agarwal, A Zani, M Firdouse, T Rouse, Q Liu, JC Correa, HK Salem, P Talving, M Worku, A Arnaud, S Tabiri, V Kalles, ML Aguilera, G Recinos, B Kumar, S Kumar, R Amandito, R Quek, F Pata, L Ansaloni, A Altibi, D Venskutonis, J Zilinskas, T Poskus, J Whitaker, V Msosa, YY Tew, A Farrugia, E Borg, A Ramos-De la Medina, Z Bentounsi, AO Ademuyiwa, K Søreide, T Gala, I Al-Slaibi, H Tahboub, OH Alser, D Romani, S Shu, P Major, A Mironescu, M Bratu, A Kourdouli, A Ndajiwo, A Altwijri, MU Alsaggaf, A Gudal, JJ Al-Faifi, S Seisay, B Lieske, S Rayne, R Spence, I Ortega, J Jeyakumar, KJ Senanayake, O Abdulbagi, Y Cengiz, D Raptis, Y Altinel, C Kong, E Teasdale, G Irwin, M Stoddart, R Kabariti, S Suresh, K Gash, R Narayanan, M Maimbo, R Balmaceda, C Fermani, MM Modolo, R Chenn, M Edye, N Gobin, E Macdermid, CO Yong, SK D'amours, D Iyer, M Jarmin, J Brown, N Phillips, D Youssef, R George, C Koh, O Warren, I Hanley, M Dickfos, C Nawara, F Primavesi, D Öfner, H Hakim, M Hussain, T Kumar, K Mahmud, AR Mitul, A Oosterkamp, PA Assouto, I Lawani, YI Souaibou, VDP Castillo, G Moreira, MM Munhoz, MC Careta, SAK Ferreira, LCB De Castro Segundo, ADL Cury, SB Kim, AV De Sousa, GP Fraga, DVD Santos, RL Simoes, GPS Miguel, BP Silvestre, AVC De Freitas, CO Felipe, LAV Laufer, JGP Vianna, F Altoe, TF Giuriato, JS Luiz, PAB Morais, ML Pimenta, LAD Silva, R Araujo, A Leal, M Leal, J Menegussi, LS Tatagiba, CVB De Lima, CL Chong, AK Tun, KP Aung, CL Chong, LS Yeo, CL Chong, GH Devadasar, MRM Qadir, S Stock, J Brown, J Kabba, TE Ngwa, S Nigo, DL Deckelbaum, A Horobjowsky, T Razek, K Bailey, B Cameron, M Livingston, A Agarwal, G Azzie, M Firdouse, S King, S Kushwaha, A Zani, N D'aguzan, E Grasset, B Marinkovic, E Grasset, J Jimenez, R Macchiavello, W Guo, J Oh, Z Zhang, F Zheng, M Mendez, I Montes, S Sierra, MCM Arango, I Mendoza, MI Villegas, FAN Aristizã¡bal, JAM Botero, VMQ Riaza, MCM Arango, C Morales, J Restrepo, MCM Arango, H Cruz, A Munera, N Pezelj, M Radic, K Zamarin, E Domini, R Karlo, J Mihanovic, M Hache-Marliere, SB Lemaire, R Rivas, MAB Fahmy, A Hassan, A Khyrallh, G Shimy, I AbdelFattah, M Abdulgawad, M Abozaid, A Adel, A Al-Mallah, M Alhendy, M Baheeg, A Elgebaly, AE Elshafay, AA Fattah, M Gemeah, A Gharib, A Gharib, A Gouda, M Hanafy, A Hasan, A Kenibar, A Menshawy, A Mohammed, A Mohammed, O Osman, O Saleh, A Sayed, M Abdelkader, M Asal, M Elfil, M Ghoneem, MEAM Gohar, A Gomaa, M Gomah, M Karkeet, A Nabawi, H Rashwan, O Alahmady, A Alkammash, AAA Ata, AM Attia, AA El Galeel, NA El Hamid, KS El-Dien, E Elbanby, AM Elkorashy, U Hantour, AHE Kotb, B Mansour, M Nasr, M Saeed, NYE Abdel-Wahab, MAF Abozyed, A Adel, GS El Sayed, SS Elkolaly, KT Lasheen, AM Saeed, EMS Taha, JH Youssif, SM Ahmed, NS El-Shahat, AEH Khedr, AM Afifi, OS Ebrahim, MM Metwally, M Abbas, M Abdelraheim, KN El Deen, AE Elnemr, AO Elsebaaye, I Elzayat, M Elzayat, I Elzayyat, D Hemeda, H Khaled, M Rashad, O Salah, M Salama, M Seisa, G Tawfik, M Warda, M Elkhadrawi, K Elshaer, A Hussein, A Abdelgelil, S Abdelghany, A Aboarab, M Aboraya, AA Al-Aarag, A El Kholy, M Elbermawy, F Elkady, A Elkholy, R Elmelegy, DME Elsawahly, S Elshanwany, R Fakher, AA Ghazy, A Haroun, E Nofal, H Safa, A Sakr, M Salma, H Samih, A Samir, S Samy, E Ghanem, G El Ashal, Y El Shoura, AM Hammad, H Khairy, A Tammam, E Abdallah, M Abdelshafy, A Abouzahra, T Alzayat, S Antar, H Elfeki, FI Elgendy, S Elsheikh, E Gamaly, MGM Hamad, M Hosh, B Magdy, S Mehrez, Y Abd-Elrasoul, M Abuseif, M Alrahawy, M Ammar, MS Ammar, SAE Barakat, FA El-Salam, A Elkelany, A Elkelany, YA Elrasoul, N Elsayed, H Elwakil, M Etman, A Eysa, Y Hegazy, M Morsi, M Mustafa, A Nasr, A Raslan, A Rslan, S Saad, A Sabry, A Sadek, O Seifelnasr, H Shaker, AG Toeema, H Zidan, H Zidan, H El-Kashef, M Shaalan, A Tarek, A Almallah, A Elwan, A Elwan, D Emadeldin, A Fouad, MA Ghonaim, AR Nayel, EA Sayma, M Seif, OSA El Hameed, AS El-Ma'doul, A Elbatahgy, DEAA Elsorogy, A Lasheen, A Mosad, HA Mostafa, AA Omar, H Tolba, YA El Salam, M Ismail, A Morsi, A Abouelnasr, A Afandy, MA Amer, M Amreia, NA Attallah, S Ayad, AA El Magd, AS El-Hamouly, HA El-badawy, A Elkelany, A Elkelany, S Elsobky, AT Hafez, A Marey, A Mokhtar, O Mosalum, M Mustafa, R Sakr, R Shaker, R Shaker, MF Zalabia, EA Ahmed, A Fadel, MM Mohamed, I AlYoussef, A Aldalaq, A Ali, D Alkhabbaz, E Alnawam, MG Alwafai, AK Aly, A Dwydar, H El-Sheemy, S Kharsa, E Mamdouh, M Elashmawy, AA Elazayem, I Elkadsh, ZM Elsayed, A Elwaey, S Ghanem, S Hussein, A Meshref, M Mousa, A Nashaat, M Saad, M Darweesh, M Hafez, A Mohameden, A Badr, A Badwy, MA El Slam, A Abdelkareem, M Aboraya, K Abozeid, S Al-Nahrawi, M Allam, M Ameen, S Aql, H Dawoud, A El Gendy, S El Mesery, M Elazoul, L Eldamaty, AOA Elhendawy, M Elsehimy, M Elshobary, A Fahiem, A Hagar, A Hashish, M Hashish, AS Marey, F Nada, S Sarsik, S Shehata, M Zidan, NM Badwi, N Elfouly, Y Elfouly, AS Elsherbiny, A Fawzy, A Gheith, MA Habeeb, A Hassan, M Husseini, Y Ibrahim, E Kasem, O Mohamed, MMH Mohammed, M Rashid, B Sieda, AR Soliman, N Starr, M Worku, NS Abebe, S Desta, S Wondimu, FA Asele, D Dabessa, E Thomas, NS Abebe, AB Zerihun, A Leppäniemi, P Mentula, V Sallinen, Q Alimi, E Gaignard, V Graffeille, Q Alimi, E Gaignard, V Graffieille, O Abbo, O Bouali, S Mouttalib, Y Aigrain, N Botto, E Hervieux, A Faure, L Fievet, N Panait, E Eyssartier, G Podevin, F Schmitt, AP Arnaud, A Martin, V Parent, A Bonnard, C Muller, M Peycelon, F Frade, S Irtan, A Scalabre, F Abantanga, K Boakye-Yiadom, M Bukari, F Owusu, J Awuku-Asabre, LD Bray, S Tabiri, A Bamicha, D Lytras, K Psarianos, E Kefalidi, G Gemenetzis, C Agalianos, C Dervenis, N Gouvas, D Karousos, M Kontos, G Kouraklis, S Germanos, C Marinos, C Anthoulakis, N Mitroudis, N Nikoloudis, S Estupinian, W Forno, G Recinos, JRA Azmitia, CCR Cabrera, M Aguilera, R Guevara, N Mendez, CAA Mendizabal, P Ramazzini, MC Urquizu, E Barrios, E Barrios, R Soley, F Tale, SMC Mérida, DEM Rodríguez, CIP Velásquez, M Lopez, F Regalado, M Siguantay, FY Lam, MF Leung, KKK Li, WS Li, T Mak, S Ng, CCL Szeto, KJ Szeto, N Gyanchandani, A Kirishnan, SS Prasad, S Bhat, SV Kinnera, A Sreedharan, BS Kumar, M Rangarajan, S Kumar, Y Reddy, C Venugopal, A Mittal, HN Lakshmi, P Malik, S Nadkarni, P Jain, N Limaye, S Pai, M Khajanchi, R Satoskar, S Satoskar, AB Mahamood, DA Soeselo, EPR Sutanto, C Tedjaatmadja, R Amandito, M Mayasari, FN Rahmawati, IAA Al-Azraqi, HII Al-Hameedi, RKMJ Al-Hasani, HI Ibraheem, R Kamil, L Sabeeh, M Shawki, MM Telfah, S Gosling, M Mccarthy, A Rasendran, M Dablouk, MO Dablouk, RW Gilbert, M Hanrahan, R Kerley, P Kielty, E Marks, L Mauro, C Normile, A Rasendran, J Sheehan, J Song, D Mirghani, SA Naqvi, CS Wong, R Cahill, S Chung, R D'cruz, DD Cadogan, C Clifford, A Driscoll, C Fahy, R Gilbert, SG Gosling, M Hanrahan, M Mccarthy, C Normile, A Powell, A Rasendran, J Song, R Bowe, C Lee, S Paul, M Hanrahan, W Hutch, K Mealy, H Mohan, M O'neill, A Bondurri, P Danelli, A Maffioli, M Pasini, G Pata, S Roncali, M Carlucci, R Faccincani, P Silvani, K Khattab, G Tugnoli, S Di Saverio, LM Cloro, MA Paludi, D Pata, A Allegri, L Ansaloni, F Coccolini, L Bortolasi, A Hasheminia, E Veronese, A Benevento, F Pata, G Tessera, MD Canto, S Cucumazzo, G Nastri, PP Grandinetti, GL Lamanna, A Maniscalco, E Rausa, G Sgroi, L Turati, A Allegri, L Ansaloni, F Coccolini, D Merlini, M Monteleone, R Villa, A Cacurri, R Cirocchi, V Grassi, L Bonavina, C Ceriani, Y Macchitella, A Diab, F Elzowawi, H Waleed, M Jokubauskas, K Varkalys, D Venskutonis, V Ambrozeviciute, R Pranevicius, S Juciute, A Skardžiukaitė, A Austraite, S Bradulskis, Z Dambrauskas, R Riauka, L Urbanavicius, D Venskutonis, J Zilinskas, P Karumnas, Z Urniezius, R Zilinskiene, A Rudzenskaite, N Kaselis, M Montrimaite, A Usaityte, K Jokubonis, A Strazdas, V Jotautas, A Kolosov, I Rakita, V Beisa, D Kazanavicius, S Mikalauskas, T Poskus, R Rackauskas, K Strupas, V Beisa, E Laugzemys, K Maceviciute, T Poskus, K Strupas, E Preckailaite, R Rakauskas, R Coomber, K Johnson, J Nowers, A Das, D Periasammy, A Salleh, NAN Abdullah, MN Kumar, RGE Tze, NR Kosai, R Rajan, M Taher, HY Chong, CC Goh, AC Roslani, M Agius, M Bezzina, E Borg, R Bugeja, J Psaila, A Spina, M Vella-Baldacchino, J Colombani, H Francois-Coridon, C Tolg, C Diaz-Zorrilla, SC Gonzalez, A Ramos-De la Medina, M Jacobe, D Mapasse, E Snyder, M Osman, R Oumer, L Anyanwu, A Mohammad, A Sheshe, A Adesina, O Faturoti, O Taiwo, MH Ibrahim, AA Nasir, SI Suleiman, A Adebanjo, A Adeniyi, O Adesanya, K Atobatele, A Ogunyemi, M Oludara, O Oshodi, R Osuoji, O Williams, A Ademuyiwa, F Alakaloko, C Bode, O Elebute, AO Lawal, A Osinowo, A Adesuyi, A Adekoya, C Nwokoro, A Tade, AE Ajao, OO Ayandipo, TA Lawal, SS Ali, B Odeyemi, S Olori, J Adeniran, A Adeyeye, A Popoola, WJ Lossius, I Havemann, JK Narvestad, K Soreide, K Thorsen, L Nymo, TB Wold, M Dar, M Elsiddig, KF Bhopal, MM Furqan, Z Iftikhar, M Jawaid, A Khalique, B Nighat, A Rashid, A Zil-E-Ali, HA Dharamshi, A Faraz, T Naqvi, AW Anwar, W Anwer, G Shamsi, GS Shamsi, T Yaseen, TM Yaseen, O Aguilera, IIZ Alvarez, HP Decoud, JM Delgado, HAS Lohse, GMM Vega, WLM Aguilar, ACM Bautista, JAC Chiong, JMV Celis, DAR Pozo, J Hamasaki, J Herrera-Matta, E Temoche, LMA Barreda, RRB Ojeda, CPG Torres, O Garaycochea, F Fujii, MC Mollo, MS De Fã, Tima Linares Delgado, WLM Aguilar, ACM Bautista, JAC Chiong, MR Castro, RA Jaramillo, GB Luque, AER Moran, ALC Vergara, SBS Yip, CAA Basto, SYA Durand, NMU Rojas, R Camacho, E Huaman, S Zegarra, A Arenas, C Hinojosa, RC Huaraya, S Limache, CE Lopez, C López, M Machaca, W Pino, CMH Puma, LM Rodriguez, GM Sila, GM Sila, MZP De Leon, MZP De Leon, J Costa-Maia, R Melo, N Muralha, F Sauvat, I Dan, P Eduard, M Hogea, M Beuran, R Bratu, I Diaconescu, F Iordache, B Martian, M Vartic, AS Mironescu, LI Muntean, LC Vida, VJP Nsengimana, A Niragire, E Niyirera, J De La Croix Allen Ingabire, E Jovine, G Landolfo, N Zanini, SA Alnuqaydan, IN Alomar, AM Altwigry, N Akeel, M Aljiffry, M Alsaggaf, A Altaf, M Bakhaidar, A Habeebullah, A Khoja, AA Maghrabi, A Nawawi, M AlRowais, A Althwainy, N Osman, M Othman, E Alqahtani, E Aljohani, R Alyami, M Alzahrani, I Alhabli, E Aljohani, S Almuallem, R Alyami, M Alzahrani, Z Mikwar, A Almoflihi, N Ghandora, A Huwait, M Al-Mousa, A Al-shammari, W Adham, S Al Awwad, B Albeladi, MA Alfarsi, M Alghamdi, A Mahdi, A Altamimi, M Hassanain, T Nouh, S Aldhafeeri, O Algohary, N Sadig, M Aledrisy, A Alrifaie, A Gudal, U Alamoudi, M Alrajraji, A Shabkah, B Alghamdi, S Aljohani, A Daqeeq, JJ Al-Faifi, V Jennings, R Moore, N Ngayu, V Kong, K Connor, H Kretzmann, D Nel, E Panieri, C Sampson, R Spence, S Rayne, N Sishuba, J Carreira, AM Mphatsoe, M Tun, E Teasdale, M Wagener, S Botes, D Du Plessis, F Fernandez-Bueno, J Aguilar-Jimenez, JA Garcia-Marin, LJG Florez, LS García, RDA Pacheco, L Barneo, C Lopez-Arevalo, G Minguez, J Pagnozzi, JHJ Quezada, JL Rodicio, R Rodríguez-Uría, JPG Stuva, P Ugalde, N Herrera, I Ortega-Vazquez, L Rodriguez, PP Arachchi, LAJJ Arachchige, WSMKJ Senanayake, DI Samaraweera, S Sivaganesh, V Thanusan, RMH Balila, MAEH Mohamed, AEK Musa, H Ali, HZ Elabdin, A Hassan, H Ahmed, SAI Idris, S Mahdi, M Elsayed, M Elsayed, M Mahmoud, M Boijsen, P Lundgren, U Gustafsson, A Kiasat, E Jurdell, A Thorell, F Wogensen, F Wogensen, L Andersson, U Gunnarsson, M Sund, H Thorarinsdottir, M Utter, SM Sundstrom, A Kjellin, C Wredberg, B Frisk, J Nyberg, S Ahlqvist, I Björklund, Y Cengiz, H Royson, P Weber, H Royson, P Weber, E Borin, H Pahlsson, M Hjertberg, V Despotidis, D Schivo, R Schmid, F Deichsel, A Gerosa, A Nocito, L Eisner, B Mijuskovic, DA Raptis, M Zuber, S Breitenstein, E Schadde, RF Staerkle, S Kruspi, KB Reinisch, C Schoewe, A Novak, AF Palma, G Teufelberger, M Kimaro, R King, AZA Balkan, M Gumar, MA Yavuz, U Karabacak, G Lap, BB Ozkan, M Karakahya, BB Ozkan, R Adams, KY Chang, KD Clement, R Gratton, L Henderson, R Mcintosh, D Mcnish, W Milligan, R Morton, H Anderson-Knight, R Lawther, B Skelly, J Onimowo, V Shatkar, S Tharmalingam, T Fautz, E Woin, O Ziff, S Arman, S Arman, S Dindyal, V Gadhvi, S Talukder, S Talukder, LS Chew, J Heath, N Blencowe, K Gash, S Hallam, GS Mannu, AC Snaith, D Zachariades, TS Hettiarachchi, A Nesaratnam, J Wheeler, JM Clements, A Khan, D McCullagh, A Ahmed, JLY Allen, J Almy, A Ashton, M Deputy, T Khan, F Koumpa, DC Marshall, CJ Mcintyre, C Neophytou, J Roth, WC Soon, J Vincent, N Behar, H Jordan, M Sykes, Y Rajjoub, T Sherman, R Ardley, A Watts, T White, T Arulampalam, D Brown, A Shah, E Blower, K Gasteratos, P Sutton, D Vimalachandran, G Irwin, C Magee, A Mcguigan, S Mcaleer, C Morgan, S Braungart, P Labib, K Lafferty, C Mangan, C Mangan, L Reza, L Reza, A Tanase, A Tanase, C Gouldthorpe, M Turner, H Woodward, TAM Malik, VK Proctor, JRL Wild, J Davies, K Hewage, A Dubois, A Grant, R Mcintyre, S Sarwary, A Zardab, BFHK Chong, W Ho, YP Mogan, E Farinella, G Humm, S Tewari, NJ Hall, CP Major, NJ Wright, J Amin, J Amin, M Attard, M Baldacchino, H Burns, JF Camilleri-Brennan, J Camilleri-Brennan, M Farhad, A Jabbar, E Macdonald, J Richards, AGN Robertson, J Skehan, J Swann, T Xerri, T Xerri, P De Bono, P De Bono, M Gimzewska, TF Hall, G Mclachlan, J Giles, J Shah, S Chiu, SMY Chiu, S Highcock, B Weber, W Beasley, S Dias, M Hassan, G Maharaj, R Mcdonald, A Vlachogiorgos, A Baird, A Macdonald, P Witherspoon, N Green, P Sarmah, H Youssef, K Cross, CM Rees, B Van Duren, E Upchurch, H Abudeeb, A Hammad, K Khan, D Bowley, S Karandikar, A Karim, O Al-Obaedi, A Bhangu, W Chachulski, K Das, G Dawnay, M Ghetia, M Ghetia, A Mistry, L Richardson, S Roy, B Thompson, DM Cocker, A Prabhudesai, JJ Tan, S Ayyar, R Tyler, F Di Franco, S Gokani, S Vivekanantham, M Gillespie, K Gudlaugsdottir, C Currow, MY Kim, T Pezas, A Ali, K Atkinson, A Birring, S Das, J Edwards, M Jha, T Fozard, J Luck, M Puttick, H Ebdewi, S El-Rabaa, G Gravante, AA Ibrahem, Y Salama, R Shah, R Allott, A Bhargava, H Nnajiuba, Z Chan, Z Hassan, A Aber, A Boddy, R Dean, D Hemingway, M Makinde, V Patel, J Parakh, S Parthiban, S Hosein, HK Ubhi, K Malik, S Ward, M Alkhouri, J Barry, C Houlden, L Jennings, MK Kang, T Newton, S Bhattacharya, A Farquharson, I Raza, K Chang, L Henderson, W Milligan, R Blundell, E Chan, I Ibrahim, PJ Lim, YN Neo, AS North, FS Peck, A Williamson, MSJ Wilson, D Fouad, A Minocha, A Chambers, E Court, K Mccarthy, C Beaton, JC Tham, J Yee, S Bokhari, M Griffiths, L Howells, J Lockey, U Walsh, L Yallop, P Jackson, O Nasher, S Singh, T Fozard, J Luck, M Puttick, WC Ho, G Pabla, AM Shariffuddin, MS Wilson, J Doughty, S Ramzi, S Zeidan, R Davenport, J Lewis, S Sinha, L Duffy, E Mcaleer, E Williams, M Boal, T Brogden, E Griffiths, N Harrison, O Javed, D Nepogodiev, H Tafazal, DJ Clark, TE Glover, RD Obute, O Javed, R Som, M Akhtar, M Boshnaq, P Capleton, S Doughan, I Mohamed, M Rabie, E Brown, E Dempster, L Dickson, A Garland, M Kennedy, N Maple, E Monaghan, D Samuel, B Wolf, D Anderson, R Anderson, A Mcphee, S Hassan, D Smith, P Sutton, C Boereboom, J Lund, J Murphy, G Tierney, S Tou, I Daniels, K Findlay-Cooper, T Stasinou, NJ Smart, AM Warwick, EF Zimmermann, R D'Souza, S Mitrasinovic, S Omara, S Ray, M Varcada, A Hanks, L Parkinson, M Spurr, E Abington, J Ma, M Ramcharn, G Williams, ED Kennedy, J Winstanley, ENW Yeung, C Fairfield, C Fairfield, SJ Fergusson, C Jones, S Koh, I Liew, SJ Lim, H Nair, S O'neill, J Oh, A Wilson, D Anandkumar, SF Ashraf, S Basson, C Chandrakumar, AJ Fowler, TF Jones, A Kirupagaran, SM Lakhani, AL Mclean, P Patel, HD Torrance, J Batt, N Benons, C Bowman, M Stoddart, R Harrison, C Mason, J Quayle, T Barker, E Harper, V Summerour, M Hampton, C Smith, TM Drake, EG Heywood, T O'Connor, SK Pitt, AE Ward, A Chowdhury, S Hossaini, NF Watson, A Chun, A Farah, D Mckechnie, H Koh, G Lim, G Sunderland, DRL Browning, PC Munipalle, H Rooney, A Chambers, L Gould, E Decker, S Giuliani, K Nemeth, B Pereira, A Shalaby, CY Chen, S Chhabra, S Chidambaram, K Kulasabanathan, A Szczap, M Benger, J Choi, M Khalili, K Patel, S Sheth, P Singh, EYA Palkhi, S Shaikh, CY Tan, J Barnacle, P Harbord, E Kostov, A Macfarlane, L Marples, R Thurairaja, K Baillie, S Hafiz, MM Palliyil, J Porter, C Raslan, M Saeed, N Soltani, M Zikry, T Boyce, E Jones, H Whewell, N Robertson, F Th'ng, S Galloway, A Mirza, H Saeed, M Afzal, G Elena, M Zakir, T Clark, C Hand, P Holton, A Livesey, P Sodde, A Sriram, IS Bharj, FM Iqbal, Y Sinha, C Jenvey, A Rotundo, R Slade, AAN Abdullah, D Donoghue, L Giacci, D Golding, S Haines, P Harrison, D Loughran, MA Sherif, A Tang, TW Tilston, D Kotecha, P Acharya, A Chapman, M Elshaer, A Riaz, J Shalhoub, T Urbonas, C Grossart, D McMorran, W Hawkins, S Loizides, M Mlotshwa, CW Ho, K Krishna, M Orchard, EE Howie, S Khan, J Shukla, F Taylor, P Thomson, O Komolafe, L Macdonald, N Mcintyre, J Cragg, J Parker, D Stewart, T Farooq, L Lintin, J Tracy, H Kaafarani, L Luque, G Molina, R Beyene, J Sava, M Scott, R Kennedy, M Swaroop, IA Azodo, T Chun, D Heffernan, A Stephen, V Punja, M Sion, MS Weinstein, N Bugaev, M Goodstein, S Razmdjou, M Hemmila, L Napolitano, K To, E Etchill, M Kesinger, JC Puyana, E Hoogakker, E Jenner, O Todd, G Galiqi, B Grizhja, S Ymeri, R Balmaceda, JM Carmona, CG Fermani, MM Modolo, S Villalobos, D Antezana, S Aviles, AEM Beleño, C Costa, R Klappenbach, B Sanchez, D Cox, P Deutschmann, D Hamill, S Sandler, M Ashtari, H Franco, S D'Amours, D Iyer, N Niranjan, D Ljuhar, R Nataraja, C Sharpin, D Gray, M Haines, S Al Amin, S Alamin, R Karim, S Roy, SA Tori, A Faruq, M Haque, F Iftekhar, TH Kanta, J Razzaque, U Salma, S Karim, AR Mitul, NF Aman, MM Estee, R Jonnalagadda, M 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Abstract
Abstract
Background
Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models.
Methods
This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July–November 2014) and GlobalSurg-2 (January–July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator (‘LASSO’)) and machine learning (extreme gradient boosting (‘XGBoost’)). Final model selection was based on prognostic accuracy and clinical utility.
Results
There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept −0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models.
Conclusion
The ‘Global Surgical-Site Infection’ score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.
Funder
National Institute for Health Research Royal College of Surgeons of Edinburgh
Publisher
Oxford University Press (OUP)
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