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A Risk Index for Sternal Surgical Wound Infection After Cardiovascular Surgery

Published online by Cambridge University Press:  02 January 2015

Michele Kohli
Affiliation:
Department of Public Health Sciences, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada Health Economics and Outcomes Research, Innovus Research Inc., Burlington, Ontario, Canada
Lilian Yuan
Affiliation:
Department of Public Health Sciences, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Michael Escobar
Affiliation:
Department of Public Health Sciences, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Tyrone David
Affiliation:
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Grant Gillis
Affiliation:
Infection Prevention and Control Unit, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada Quality Program, Canadian Standards Association International, Toronto, Ontario, Canada
Marta Garcia
Affiliation:
Infection Prevention and Control Unit, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
John Conly*
Affiliation:
Infection Prevention and Control Unit, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada Pathology and Laboratory Medicine, and Microbiology & Infectious Diseases, Division of Microbiology, Calgary Laboratory Services, Calgary Health Region and University of Calgary, Calgary, Alberta, Canada
*
Hospital Epidemiologist, University Health Network, Room 118, NU-13, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2C4, Canada

Abstract

Objectives:

To identify factors that increase the risk of sternal surgical wound infection after cardiovascular surgery and to develop a bedside clinical risk index using these factors.

Design:

A risk index was developed using clinical data collected from a cohort of 11,508 cardiac surgery patients and validated using three independent subsets of the data. With two of these subsets, we derived a logistic regression equation and then modified the scoring algorithm to simplify the calculation of patient risk scores by clinicians. The final subset was used to validate the index. The area under the receiver operating characteristic (aROC) curve was the primary measure of goodness of fit.

Setting:

Toronto General Hospital, a teaching hospital and the largest center for cardiac surgery in Ontario, Canada.

Patients:

Cardiac surgery patients receiving cardiopulmonary bypass between April 1, 1990, and December 31, 1995, who survived at least 6 days after surgery.

Results:

Variables that were used to construct the risk index included reoperation due to complication (odds ratio, 4.3; range, 1.9 to 8.5), diabetes (odds ratio, 2.4; range, 1.5 to 3.7), more than 3 days in the intensive care unit (odds ratio, 5.4; range, 3.2 to 8.7), and use of the internal mammary artery for revascularization (odds ratio, 3.2; range, 1.7 to 5.8). Validation showed that the index had an aROC curve of 0.64.

Conclusions:

The risk index described in this article allows clinicians to quickly stratify patients into four risk groups associated with an increasing risk of sternal surgical wound infection. It may be used perioperatively or as part of a wound infection surveillance system.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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