Individualized risk of surgical-site infection: an application of the breast reconstruction risk assessment score

John Y.S. Kim, Nima Khavanin, Sumanas W. Jordan, Jon P. ver Halen, Alexei S. Mlodinow, Kevin P. Bethke, Seema A. Khan, Nora M. Hansen, Albert Losken, Neil A. Fine

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


BACKGROUND: Risk factors for surgical-site infection following beast reconstruction have been thoroughly investigated at a population level. However, traditional population-based measures may not always capture the nuances of individual patients. The authors aimed to develop a validated breast reconstruction risk assessment calculator for surgical-site infection that informs risk at an individual level.

METHODS: Mastectomies with immediate reconstruction (n = 16,069) from 2005 to 2011 were identified from the National Surgical Quality Improvement Program database. A multiple logistic regression model was created for postoperative surgical-site infection. Hosmer-Lemeshow, C statistic, and Brier score were computed to assess model performance. Bootstrap analysis validated the model.

RESULTS: A robust, validated risk model for surgical-site infection was developed using 11 covariates. The model Hosmer-Lemeshow p value was 0.371, the Brier score was 0.0357, and the C statistic was 0.682 (optimism-corrected C statistic, 0.678). The distribution of individual risks demonstrated a positive skew. Population-derived risk underestimated or overestimated individual risk by at least 1.5-fold in nearly one-fifth of all patients.

CONCLUSIONS: The breast reconstruction risk assessment score risk calculator for surgical-site infection mitigates the potentially inaccurate interpolation of population-based risk to individual patients. The authors concomitantly developed an online interface-accessible by patients and surgeons alike-to quantify a patient's risk for surgical-site infection, better informing evidence-based decisions and managing patient expectations.


Original languageEnglish (US)
Pages (from-to)351e-362e
JournalPlastic and reconstructive surgery
Issue number3
StatePublished - Sep 1 2014

ASJC Scopus subject areas

  • Surgery


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