Fausto Biancari1,2, Giuseppe Gatti3, Stefano Rosato4, Giovanni Mariscalco5, Aniello Pappalardo3, Francesco Onorati6, Giuseppe Faggian6, Antonio Salsano7, Francesco Santini7, Vito G Ruggieri8, Andrea Perrotti9, Giuseppe Santarpino10,11, Theodor Fischlein11, Matteo Saccocci12, Francesco Musumeci13, Antonino S Rubino14,15, Marisa De Feo15, Ciro Bancone15, Francesco Nicolini16, Eeva-Maija Kinnunen2, Till Demal17, Paola D'Errigo4, Tatu Juvonen2,18, Magnus Dalén19, Daniele Maselli20. 1. Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland. 2. Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland. 3. Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy. 4. National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy. 5. Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom. 6. Department of Cardiac Surgery, Verona University Hospital, Verona, Italy. 7. Division of Cardiac Surgery, IRCCS Ospedale Policlinico San MartinoGenoa, Italy. 8. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, and Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 9. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 10. Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care and Research, Lecce, Italy. 11. Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. 12. Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, Milan, Italy. 13. Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy. 14. Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy. 15. Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. 16. Division of Cardiac Surgery, University of Parma, Parma, Italy. 17. Hamburg University Heart Center, Hamburg, Germany. 18. Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 19. Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 20. Department of Cardiac Surgery, St Anna Hospital, Catanzaro, Italy.
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.
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.
Authors: Janusz Konstanty-Kalandyk; Anna Kędziora; Piotr Mazur; Radosław Litwinowicz; Bogusław Kapelak; Jacek Piątek Journal: PLoS One Date: 2021-12-22 Impact factor: 3.240