Beyond Individual Risk Factors: A Composite Assessment of Preoperative Modifiable Risks and Surgical Site Infection

Sirjana Kaur Dhaliwal; Prasanth Prabu Velmurugan; Piyush Kumar Tiwari; Shorya; Anusha Priyanka Chakravarthy

Beyond Individual Risk Factors: A Composite Assessment of Preoperative Modifiable Risks and Surgical Site Infection

Author(s)	Sirjana Kaur Dhaliwal, Prasanth Prabu Velmurugan, Piyush Kumar Tiwari, Shorya, Anusha Priyanka Chakravarthy
Country	India
Abstract	Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections occurring after surgical procedures and remains a major cause of postoperative morbidity, prolonged hospital stay, and increased healthcare expenditure. Although individual risk factors such as diabetes mellitus, obesity, smoking, anemia, and malnutrition have been widely studied, the combined effect of these modifiable preoperative risks has not been adequately evaluated. A composite risk assessment may provide a more accurate estimation of the likelihood of SSI. Aim: To evaluate the association between a composite preoperative modifiable risk score and the occurrence of surgical site infection in patients undergoing elective surgical procedures. Methods: A prospective observational study was conducted among 220 patients undergoing elective surgery in a tertiary care hospital over a period of 18 months. Preoperative modifiable risk factors including smoking status, body mass index, glycemic status, hemoglobin level, serum albumin level, and duration of preoperative hospital stay were assessed. A composite modifiable risk index (CMRI) was developed by assigning a score to each risk factor. Patients were followed for 30 days postoperatively to identify surgical site infections based on CDC criteria. Statistical analysis included chi-square test, correlation analysis, and multivariate logistic regression. Results: The overall incidence of SSI was 13.6%. Patients with higher composite risk scores showed significantly increased SSI rates compared with those with lower scores (p <0.001). Multivariate analysis demonstrated that CMRI ≥3 independently predicted SSI (OR 4.78, 95% CI 2.01–11.32). Among individual factors, uncontrolled diabetes, anemia, and hypoalbuminemia were strongly associated with infection. Conclusion: Composite assessment of modifiable preoperative risk factors provides a more reliable prediction of surgical site infection than evaluation of isolated risk factors. Preoperative optimization of these factors may significantly reduce postoperative infection rates.
Keywords	Surgical site infection, modifiable risk factors, composite risk score, postoperative infection, risk assessment.
Field	Medical / Pharmacy
Published In	Volume 7, Issue 2, March-April 2026
Published On	2026-03-28

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Beyond Individual Risk Factors: A Composite Assessment of Preoperative Modifiable Risks and Surgical Site Infection

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