Preoperative risk stratification of deep sternal wound infection after coronary surgery

Fausto Biancari, Giuseppe Gatti, Stefano Rosato, Giovanni Mariscalco, Aniello Pappalardo, Francesco Onorati, Giuseppe Faggian, Antonio Salsano, Francesco Santini, Vito G. Ruggieri, Andrea Perrotti, Giuseppe Santarpino, Theodor Fischlein, Matteo Saccocci, Francesco Musumeci, Antonino S. Rubino, Marisa De Feo, Ciro Bancone, Francesco Nicolini, Eeva Maija KinnunenTill Demal, Paola D'Errigo, Tatu Juvonen, Magnus Dalén, Daniele Maselli

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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.

Original languageEnglish
JournalInfection Control and Hospital Epidemiology
DOIs
Publication statusAccepted/In press - Jan 1 2020

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ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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Biancari, F., Gatti, G., Rosato, S., Mariscalco, G., Pappalardo, A., Onorati, F., Faggian, G., Salsano, A., Santini, F., Ruggieri, V. G., Perrotti, A., Santarpino, G., Fischlein, T., Saccocci, M., Musumeci, F., Rubino, A. S., De Feo, M., Bancone, C., Nicolini, F., ... Maselli, D. (Accepted/In press). Preoperative risk stratification of deep sternal wound infection after coronary surgery. Infection Control and Hospital Epidemiology. https://doi.org/10.1017/ice.2019.375