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HCV Transmission by Tattooing

were not observed for non-abdominal surgery, but only 30 infections occurred in this group. The difference between the proportion of our patients scoring 0 in the SENIC index, 16%, and that of Haley et al4 and Culver et al,3 46% to 47%, can be explained easily: our study was performed on patients admitted to a general surgery service, whereas the SENIC study and the NNIS study were based on patients admitted to all surgical services. In our study population, 1,187 patients (80%) underwent abdominal surgery, and 125 of them became infected (10.5%). A similar rate of infection was found for nonabdominal surgery (30/296=10.1%). The fact that one of the variables (abdominal surgery) scored in the SENIC index did not behave as a risk factor for surgical-site infection in our population may be one explanation of why the SENIC index showed a lower predictive ability than did the NNIS index. However, in biliary tract surgery, where this factor is obviated (all patients underwent abdominal surgery), the NNIS index did show a better predictive ability than the SENIC index. Nonetheless, one should be cautious in drawing conclusions on analyses done on subgroups with small sample sizes. We have no explanation for the lower risk of infection observed in the highest category of the NNIS index (Table 3). However, only nine patients scored 3 in the NNIS index; this result may be a fluke of small sample size. Similarly, the decreasing infection risk with higher scores of the NNIS index seen for a SENIC level >3 (Table 4) simply may reflect the fact that only 43 patients had a SENIC index >3, and they were divided among three categories of the NNIS index. In conclusion, our results suggest that the NNIS index is better than the SENIC index for discriminating and predicting the risk of surgicalwound infection.