Preoperative risk stratification of deep sternal wound infection after coronary surgery
: Fausto Biancari, Giuseppe Gatti, Stefano Rosato, Giovanni Mariscalco, Aniello Pappalardo, Francesco Onorati, Giuseppe Faggian, Antonio Salsano, Francesco Santini, Vito G Ruggieri, Andrea Perrotti, Giuseppe Santarpino, Theodor Fischlein, Matteo Saccocci, Francesco Musumeci, Antonino S Rubino, Marisa De Feo, Ciro Bancone, Francesco Nicolini, Eeva-Maija Kinnunen, Till Demal, Paola D'Errigo, Tatu Juvonen, Magnus Dalén, Daniele Maselli
Publisher: Cambridge University Press
: Cambridge
: 2020
Infection Control and Hospital Epidemiology
: Infection Control and Hospital Epidemiology
: 41
: 4
: 444
: 451
: 8
: 0899-823X
: 1559-6834
DOI: https://doi.org/10.1017/ice.2019.375
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/1.73 m2 (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.
