Abstract
Various scoring systems attempt to predict the risk of surgical site infection (SSI) after cardiac surgery, but their discrimination is limited. Our aim was to analyze all SSI risk factors in both coronary artery bypass graft (CABG) and valve replacement patients in order to create a new SSI risk score for such individuals. A priori prospective collected data on patients that underwent cardiac surgery (n = 2020) were analyzed following recommendations from the Reporting of studies Conducted using Observational Routinely collected health Data (RECORD) group. Study participants were divided into two periods: the training sample for defining the new tool (2010–2014, n = 1298), and the test sample for its validation (2015–2017, n = 722). In logistic regression, two preoperative variables were significantly associated with SSI (odds ratio (OR) and 95% confidence interval (CI)): diabetes, 3.3/2–5.7; and obesity, 4.5/2.2–9.3. The new score was constructed using a summation system for punctuation using integer numbers, that is, by assigning one point to the presence of either diabetes or obesity. The tool performed better in terms of assessing SSI risk in the test sample (area under the Receiver-Operating Characteristic curve (aROC) and 95% CI, 0.67/055–0.76) compared to the National Nosocomial Infections Surveillance (NNIS) risk index (0.61/0.50–0.71) and the Australian Clinical Risk Index (ACRI) (0.61/0.50–0.72). A new two-variable score to preoperative SSI risk stratification of cardiac surgery patients, named Infection Risk Index in Cardiac surgery (IRIC), which outperforms other classical scores, is now available to surgeons. Personalization of treatment for cardiac surgery patients is needed.
Highlights
Patients who undergo operations can present numerous complications, among which infections stand out owing to their frequency and severity [1,2,3]
Real figures of incidence vary depending on the type of surgical procedure, study design, and definitions used to classify the infection, the risk of this complication is a concern among physicians [8,9,10,11,12]
No differences were observed between the patients in the training and test samples (Supplementary Table S1), which included patients with diabetes mellitus (DM) (27%), chronic kidney disease (9%), peripheral artery disease (7%), and obesity (5%)
Summary
Patients who undergo operations can present numerous complications, among which infections stand out owing to their frequency and severity [1,2,3]. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the most frequently used scale for patient risk stratification in Europe This scale is used to predict mortality and the appearance of complications, kidney failure, and its performance in coronary intervention settings has been well-studied [13]. The Centers for Disease Control and Prevention (CDC) has proposed a method called the National Nosocomial Infections Surveillance (NNIS) risk index in an attempt to reduce SSI risk in surgical procedures [14]. This index combines the following three variables: level of contamination of the surgical wound, the American Society of Anesthesiologists (ASA) pre-anesthesia score, and the duration of the surgical procedure [15]. The NNIS risk index is internationally accepted, its predictive power has certain limitations in cardiac surgery setting, given the prolonged duration of common surgical procedures [16]
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