Validation and reliability of the Turkish version of the surgical site infection assessment scale: a methodological study

Abstract

Background Although the incidence of healthcare-associated infections has decreased over the past decade, surgical site infections (SSIs) have continued to constitute a significant proportion of these infections. Therefore, early identification and management of high-risk patients has been crucial in reducing the incidence of SSIs. Objectives In this study, we aimed to evaluate the validity and reliability of the Turkish version of the Surgical Site Infection Assessment Scale (SSIAS), which was developed to identify patients at risk of superficial incisional SSI. Methods In this methodological study, we evaluated the Turkish validity and reliability of the SSIAS in a prospective cross-sectional sample of 170 patients who underwent elective abdominal surgery at a tertiary healthcare center. The scale was adapted in accordance with international guidelines through a forward-backward translation process performed by three professional translators and content validation by a panel of 20 experts. We assessed the psychometric properties using univariate logistic regression and ROC analysis for construct validity (AUC calculation). Diagnostic accuracy was evaluated based on sensitivity, specificity, and predictive values at the optimal cutoff point (> 14), determined using the Youden index. Results The adaptation process was carried out based on Beaton et al.'s guidelines, and the content validity ratio (CVR) was calculated between 0.78 and 1.00. ROC analysis revealed an AUC of 0.935 (95% CI: 0.897-0.972), and at the > 14 cutoff point, we observed 91.8% sensitivity and 79.3% specificity. The scale demonstrated superior predictive performance compared to previously developed tools. Surgical site infections occurred in 49 patients. The mean scale score of infected patients was 16.76 +/- 1.85. For each one-point increase in the scale score, the risk of infection increased by 3.52 times. Smoking, comorbidities, abnormal laboratory findings, length of preoperative hospitalization, wound classification, body temperature, and prolonged presence of drains were identified as factors influencing the risk of infection. Conclusion The Turkish version of the Surgical Site Infection Assessment Scale (SSIAS), originally developed by Anwar et al., was found to be a valid and reliable tool for predicting SSI risk in T & uuml;rkiye. Due to its high predictive power, it offers practical potential for early risk identification and preventive action in clinical settings.