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Preoperative risk stratification of deep sternal wound infection after coronary surgery

Published online by Cambridge University Press:  20 January 2020

Fausto Biancari*
Affiliation:
Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
Giuseppe Gatti
Affiliation:
Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
Stefano Rosato
Affiliation:
National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
Giovanni Mariscalco
Affiliation:
Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
Aniello Pappalardo
Affiliation:
Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
Francesco Onorati
Affiliation:
Department of Cardiac Surgery, Verona University Hospital, Verona, Italy
Giuseppe Faggian
Affiliation:
Department of Cardiac Surgery, Verona University Hospital, Verona, Italy
Antonio Salsano
Affiliation:
Division of Cardiac Surgery, IRCCS Ospedale Policlinico San MartinoGenoa, Italy
Francesco Santini
Affiliation:
Division of Cardiac Surgery, IRCCS Ospedale Policlinico San MartinoGenoa, Italy
Vito G. Ruggieri
Affiliation:
Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, and Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
Andrea Perrotti
Affiliation:
Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
Giuseppe Santarpino
Affiliation:
Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care and Research, Lecce, Italy Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
Theodor Fischlein
Affiliation:
Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
Matteo Saccocci
Affiliation:
Department of Cardiac Surgery, Centro Cardiologico – Fondazione Monzino IRCCS, Milan, Italy
Francesco Musumeci
Affiliation:
Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
Antonino S. Rubino
Affiliation:
Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Marisa De Feo
Affiliation:
Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Ciro Bancone
Affiliation:
Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Francesco Nicolini
Affiliation:
Division of Cardiac Surgery, University of Parma, Parma, Italy
Eeva-Maija Kinnunen
Affiliation:
Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
Till Demal
Affiliation:
Hamburg University Heart Center, Hamburg, Germany
Paola D’Errigo
Affiliation:
National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
Tatu Juvonen
Affiliation:
Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
Magnus Dalén
Affiliation:
Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Daniele Maselli
Affiliation:
Department of Cardiac Surgery, St Anna Hospital, Catanzaro, Italy
*
Author for correspondence: Fausto Biancari, E-mail: faustobiancari@yahoo.it

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/1.73 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

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Supplementary material: File

Biancari et al. supplementary material

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