Background: Many risk factors for postoperative infections have been identified that can be
used individually or in combination as scoring indices.
Methods: Infection risk scores can be applied in clinical practice to identify high-risk surgical
patients, to indicate the need to implement risk-reduction strategies, and to stratify risk
for comparison of outcome among different patient series.
Results: In the hierarchy of patient-related risk factors, serum albumin concentration and
advanced age rank at the top of the list. Among the treatment-related factors, the quality of
the surgical technique is a most important determinant, although most surgical site infections
are attributable to patient-related risk factors rather than to flawed surgical care. Scoring systems
can identify the patients at highest risk, thus prompting the implementation of therapy
to improve modifiable conditions, but most clinicians outside the academic and research setting
do not use them. Risk assessment also can be performed by expert clinical judgment.
Discussion with the patient and informed consent are essential.
Conclusions: Carefully collected scores of patient risk factors may be valuable to document
the relations between the risk and the outcome of surgery. Ideally, each institution should
select a validated scoring system to audit postoperative infectious morbidity and surgical performance
in the various specialties.
