Surgical-site infections (SSIs) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. From 1986 to 1996, the National Nosocomial Infections Surveillance system of the Centers for Disease Control and Prevention reported 15,523 SSIs following 593,344 operations (2.6%). Previous studies have documented patient characteristics associated with an increased risk of SSI, including diabetes, tobacco or steroid use, obesity, malnutrition, and perioperative blood transfusion. Malone and colleagues from the Department of Surgery, Veterans Administration Maryland Health Care System, Baltimore, conducted a study to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients. Prospective data (NSQIP) were collected on 5,031 noncardiac surgical patients at the Veterans Administration Maryland Healthcare System from 1995 to 2000. All preoperative risk factors were evaluated as independent predictors of SSI. The mean age of the study cohort was 61 (± 13) years. SSIs occurred in 162 patients, comprising 3.2% of the study cohort. Gram-positive organisms were the most common bacterial etiology. Multiple logistic regression analysis documented that diabetes (insulin-dependent and non-insulindependent), low postoperative hematocrit, weight loss (within 6 months), and ascites were significantly associated with increased risk of SSI. Tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not predictors for SSI. This study confirms that diabetes and malnutrition (defined as significant weight loss 6 months prior to surgery) are significant preoperative risk factors for SSI. Postoperative anemia is a significant risk factor for SSI. In contrast to prior analyses, this study showed that tobacco use, steroid use, and COPD were not independent predictors of SSI. FROM: Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM Surgical site infections: reanalysis of risk factors. / Surg Res 2002;103:89-95.