학술논문
Preoperative risk stratification of deep sternal wound infection after coronary surgery
Document Type
Article
Author
Biancari, Fausto; Gatti, Giuseppe; Rosato, Stefano; Mariscalco, Giovanni; Pappalardo, Aniello; Onorati, Francesco; Faggian, Giuseppe; Salsano, Antonio; Santini, Francesco; Ruggieri, Vito G.; Perrotti, Andrea; Santarpino, Giuseppe; Fischlein, Theodor; Saccocci, Matteo; Musumeci, Francesco; Rubino, Antonino S.; De Feo, Marisa; Bancone, Ciro; Nicolini, Francesco; Kinnunen, Eeva-Maija; Demal, Till; D’Errigo, Paola; Juvonen, Tatu; Dalén, Magnus; Maselli, Daniele
Source
Infection Control & Hospital Epidemiology; April 2020, Vol. 41 Issue: 4 p444-451, 8p
Subject
Language
ISSN
0899823X; 15596834
Abstract
AbstractObjective: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.Trial registration:clinicaltrials.gov identifier: NCT02319083