Objective: To develop a risk score for deep sternal wound infection (DSWI) after isolated coronary artery bypass grafting (CABG). Design: Multicenter, prospective study. Setting: Tertiary-care referral hospitals. Participants: The study included 7,352 patients from the European multicenter coronary artery bypass grafting (E-CABG) registry. Intervention: Isolated CABG. Methods: An additive risk score (the E-CABG DSWI score) was estimated from the derivation data set (66.7% of patients), and its performance was assessed in the validation data set (33.3% of patients). Results: DSWI occurred in 181 (2.5%) patients and increased 1-year mortality (adjusted hazard ratio, 4.275; 95% confidence interval [CI], 2.804–6.517). Female gender (odds ratio [OR], 1.804; 95% CI, 1.161–2.802), body mass index ≥30 kg/m2 (OR, 1.729; 95% CI, 1.166–2.562), glomerular filtration rate <45 mL/min/1.73m2 (OR, 2.410; 95% CI, 1.413–4.111), diabetes (OR, 1.741; 95% CI, 1.178–2.573), pulmonary disease (OR, 1.935; 95% CI, 1.178–3.180), atrial fibrillation (OR, 1.854; 95% CI, 1.096–3.138), critical preoperative state (OR, 2.196; 95% CI, 1.209–3.891), and bilateral internal mammary artery grafting (OR, 2.088; 95% CI, 1.422–3.066) were predictors of DSWI (derivation data set). An additive risk score was calculated by assigning 1 point to each of these independent risk factors for DSWI. In the validation data set, the rate of DSWI increased along with the E-CABG DSWI scores (score of 0, 1.0%; score of 1, 1.8%; score of 2, 2.2%; score of 3, 6.9%; score ≥4: 12.1%; P < .0001). Net reclassification improvement, integrated discrimination improvement, and decision curve analysis showed that the E-CABG DSWI score performed better than other risk scores. Conclusions: DSWI is associated with poor outcome after CABG, and its risk can be stratified using the E-CABG DSWI score.
Preoperative risk stratification of deep sternal wound infection after coronary surgery / 128., B.F., Gatti, G., Rosato, S., Mariscalco, G., Pappalardo, A., Onorati, F., Faggian, G., Salsano, A., Santini, F., Ruggieri, V.g., Perrotti, A., Santarpino, G., Fischlein, T., Saccocci, M., Musumeci, F., Rubino, A.s., De Feo, M., Bancone, C., Nicolini, F., Kinnunen, E.m., et al.. - In: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY. - ISSN 0899-823X. - 41:4(2020), pp. 444-451. [10.1017/ice.2019.375]
Preoperative risk stratification of deep sternal wound infection after coronary surgery.
Nicolini F;
2020-01-01
Abstract
Objective: To develop a risk score for deep sternal wound infection (DSWI) after isolated coronary artery bypass grafting (CABG). Design: Multicenter, prospective study. Setting: Tertiary-care referral hospitals. Participants: The study included 7,352 patients from the European multicenter coronary artery bypass grafting (E-CABG) registry. Intervention: Isolated CABG. Methods: An additive risk score (the E-CABG DSWI score) was estimated from the derivation data set (66.7% of patients), and its performance was assessed in the validation data set (33.3% of patients). Results: DSWI occurred in 181 (2.5%) patients and increased 1-year mortality (adjusted hazard ratio, 4.275; 95% confidence interval [CI], 2.804–6.517). Female gender (odds ratio [OR], 1.804; 95% CI, 1.161–2.802), body mass index ≥30 kg/m2 (OR, 1.729; 95% CI, 1.166–2.562), glomerular filtration rate <45 mL/min/1.73m2 (OR, 2.410; 95% CI, 1.413–4.111), diabetes (OR, 1.741; 95% CI, 1.178–2.573), pulmonary disease (OR, 1.935; 95% CI, 1.178–3.180), atrial fibrillation (OR, 1.854; 95% CI, 1.096–3.138), critical preoperative state (OR, 2.196; 95% CI, 1.209–3.891), and bilateral internal mammary artery grafting (OR, 2.088; 95% CI, 1.422–3.066) were predictors of DSWI (derivation data set). An additive risk score was calculated by assigning 1 point to each of these independent risk factors for DSWI. In the validation data set, the rate of DSWI increased along with the E-CABG DSWI scores (score of 0, 1.0%; score of 1, 1.8%; score of 2, 2.2%; score of 3, 6.9%; score ≥4: 12.1%; P < .0001). Net reclassification improvement, integrated discrimination improvement, and decision curve analysis showed that the E-CABG DSWI score performed better than other risk scores. Conclusions: DSWI is associated with poor outcome after CABG, and its risk can be stratified using the E-CABG DSWI score.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
