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Validating a 3-Point Prediction Rule for Surgical Site Infection after Coronary Artery Bypass Surgery

Published online by Cambridge University Press:  02 January 2015

Luke F. Chen ,
Deverick J. Anderson ,
Keith S. Kaye  and
Daniel J. Sexton
Luke F. Chen*
Affiliation:
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
Keith S. Kaye
Affiliation:
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
*
2100 Erwin Road, Durham, NC (Luke.Chen@Duke.edu)
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Extract

Background.

Surgical site infection (SSI) after coronary artery bypass graft (CABG) surgery is an increasing healthcare problem. Investigators from Australia proposed a new, 3-point scale that assesses SSI risk on the basis of diagnosis of diabetes mellitus and body mass index.

Objective.

To validate the Australian Clinical Risk Index among patients undergoing CABG surgery in the United States.

Design and Setting.

Nested case-control study involving patients undergoing CABG surgery at 9 hospitals during 1991-2002.

Patients.

Case patients were those who developed SSIs after CABG surgery. Control subjects were matched to case patients on the basis of hospital, age, and procedure date.

Methods.

Odds ratios (ORs) for SSIs were calculated for the comparison of case patients with control subjects for all risk categories determined using the Australian Clinical Risk Index and National Nosocomial Infections Surveillance System (NNIS) risk index. An adjusted area under the curve was used to compare predictive values among risk indices.

Results.

Four hundred sixty patients were studied, including 269 patients with SSI and 191 control subjects. NNIS risk group 2 was associated with increased rate of SSI (OR, 1.79; 95% confidence interval [CI], 1.19-2.67). No patient had an NNIS risk index of 3. The remaining NNIS categories were not predictive of infection. In contrast, an increase in Australian Clinical Risk Index was associated with an increase in risk of SSI (category 2: OR, 2.39 [95% CI, 1.33-4.29]; category 3: OR, 4.46 [95% CI, 1.83-10.85]).

Conclusions.

The NNIS risk index predicts the risk of SSI associated with many procedures, but it has limited use in predicting the risk of SSI after CABG surgery. The new Australian Clinical Risk Index stratified patients into discrete groups associated with increased risk of SSI. Data from our study support the use of this new risk index in the US population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 64 - 68
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159–167.CrossRefGoogle Scholar
2.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.CrossRefGoogle ScholarPubMed
3.Martone, WJ, Nichols, RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis 2001;33(Suppl 2):S67–S68.Google Scholar
4.Weinstein, RA. Nosocomial infection update. Emerg Infect Dis 1998;4:416–420.CrossRefGoogle ScholarPubMed
5.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S–157S.CrossRefGoogle ScholarPubMed
6. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
7.Friedman, ND, Bull, AL, Russo, PL, Gurrin, L, Richards, M. Performance of the national nosocomial infections surveillance risk index in predicting surgical site infection in australia. Infect Control Hosp Epidemiol 2007;28:55–59.CrossRefGoogle ScholarPubMed
8.Gaynes, RP. Surgical-site infections and the NNIS SSI risk index: room for improvement. Infect Control Hosp Epidemiol 2000;21:184–185.Google Scholar
9.Friedman, ND, Bull, AL, Russo, PL, et al. An alternative scoring system to predict risk for surgical site infection complicating coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2007;28:1162–1168.Google Scholar
10.Horan, TC, Edwards, JR, Culver, DH, Gaynes, RP. Risk factors for incisional surgical site infection after cesarean section: results of a 5-year multicenter study [abstract P151]. In: Program and abstracts of the 4th Decennial International Conference of Nosocomial and Healthcare-Associated Infections (Atlanta). 2000.Google Scholar
11.Roy, MC, Herwaldt, LA, Embrey, R, Kuhns, K, Wenzel, RP, Perl, TM. Does the Centers for Disease Control's NNIS system risk index stratify patients undergoing cardiothoracic operations by their risk of surgical-site infection? Infect Control Hosp Epidemiol 2000;21:186–190.Google Scholar
12.Horan, TC, Emori, TG. Definitions of key terms used in the NNIS system. Am J Infect Control 1997;25:112–116.CrossRefGoogle ScholarPubMed
13.Fowler, V Jr, O'Brien, SM, Muhlbaier, LH, Corey, GR, TB, Ferguson, Peterson, ED. Clinical predictors of major infections after cardiac surgery. Circulation 2005;112(Suppl):1358–1365.CrossRefGoogle ScholarPubMed
14.Wenzel, RP. Prevention and control of nosocomial infections. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar