Fatores de risco para infecção de ferida esternal e aplicação do escore da STS em pacientes submetidos à cirurgia de revascularização miocárdica

Farsky, Pedro Sílvio; Graner, Humberto; Duccini, Pedro; Zandonadi, Eliana da Cassia; Amato, Vivian Lerner; Anger, Jaime; Sanches, Antonio Flavio de Almeida; Abboud, Cely Saad

doi:10.5935/1678-9741.20110054

Cited by 31 publications

(12 citation statements)

References 30 publications

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“…Diez et al [12] related the etiology of DSWI in obese patients with bradytrophic properties of adipose tissue that contribute to poor healing of wounds. Farsky et al [13] also found a BMI > 40 kg/m 2 to be an independent predictor of DSWI after CABG among 1975 Brazilian patients.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Ferraz¹,

Soares²,

Miranda³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveDeep sternal wound infection following coronary artery bypass grafting is a serious complication associated with significant morbidity and mortality. Despite the substantial impact of deep sternal wound infection, there is a lack of specific risk stratification tools to predict this complication after coronary artery bypass grafting. This study was undertaken to develop a specific prognostic scoring system for the development of deep sternal wound infection that could risk-stratify patients undergoing coronary artery bypass grafting and be applied right after the surgical procedure.MethodsBetween March 2007 and August 2016, continuous, prospective surveillance data on deep sternal wound infection and a set of 27 variables of 1500 patients were collected. Using binary logistic regression analysis, we identified independent predictors of deep sternal wound infection. Initially we developed a predictive model in a subset of 500 patients. Dataset was expanded to other 1000 consecutive cases and a final model and risk score were derived. Calibration of the scores was performed using the Hosmer-Lemeshow test.ResultsThe model had area under Receiver Operating Characteristic (ROC) curve of 0.729 (0.821 for preliminary dataset). Baseline risk score incorporated independent predictors of deep sternal wound infection: obesity (P=0.046; OR 2.58; 95% CI 1.11-6.68), diabetes (P=0.046; OR 2.61; 95% CI 1.12-6.63), smoking (P=0.008; OR 2.10; 95% CI 1.12-4.67), pedicled internal thoracic artery (P=0.012; OR 5.11; 95% CI 1.42-18.40), and on-pump coronary artery bypass grafting (P=0.042; OR 2.20; 95% CI 1.13-5.81). A risk stratification system was, then, developed.ConclusionThis tool effectively predicts deep sternal wound infection risk at our center and may help with risk stratification in relation to public reporting and targeted prevention strategies in patients undergoing coronary artery bypass grafting.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Ferraz¹,

Soares²,

Miranda³

et al. 2017

Braz J Cardiovasc Surg

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“…From the best of our knowledge it is the first time that the complete set of risk prediction scores is tested in a Brazilian sample and, considering the presented data, it is likely that STS methodology is useful as a tool to safely predict postoperative outcomes after CABG, although further evaluation on larger population samples are needed. Previously, other initiatives have tested individual aspects of the method for one single complication, namely wound sternal infection [ 12 , 13 ] , but never in a similar number of subjects.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Society of Thoracic Surgeons score system for isolated coronary bypass graft surgery in a Brazilian population

Ikeoka¹,

Fernandes²,

Gebara³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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ObjectiveReport the experience with the Society of Thoracic Surgeons scoring system in a Brazilian population submitted to isolated coronary artery bypass graft surgery.MethodsData were collected from January-2010 to December-2011, and analyzed to determine the performance of the Society of Thoracic Surgeons scoring system on the determination of postoperative mortality and morbidity, using the method of the receiver operating characteristic curve as well as the Hosmer-Lemeshow and the Chi-square goodness of fit tests. From the 1083 cardiac surgeries performed during the study period 659 represented coronary artery bypass graft procedures which are included in the present analysis. Mean age was 61.4 years and 77% were men.ResultsGoodness of fit tests have shown good calibration indexes both for mortality (X2=6.78, P=0.56) and general morbidity (X2=6.69, P=0.57). Analysis of area under the ROC-curve (AUC) demonstrated a good performance to detect the risk of death (AUC 0.76; P<0.001), renal failure (AUC 0.79; P<0.001), prolonged ventilation (AUC 0.80; P<0.001), reoperation (AUC 0.76; P<0.001) and major morbidity (AUC 0.75; P<0.001) which represents the combination of the assessed postoperative complications. STS scoring system did not present comparable results for short term hospital stay, prolonged length of hospital stay and could not be properly tested for stroke and wound infection.ConclusionSociety of Thoracic Surgeons scoring system presented a good calibration and discrimination in our population to predict postoperative mortality and the majority of the harmful events following coronary artery bypass graft surgery. Analysis of larger samples might be needed to further validate the use of the score system in Brazilian populations.

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“…1 sternal wound infection [11] and mediastinitis [12,13]. In this series, there was not higher incidency of sepsis, sternal wound infection or lower limb wound infection, probably due to lack of statistical power, due to its relatively small sample to show such relation.…”

Section: Discussionmentioning

confidence: 84%

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

Júnior¹,

Pereira²,

Valle³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Introduction: Diabetes is a well known risk factor for early and late adverse outcomes in patients undergoing coronary artery bypass graft surgery (CABG); however, few studies have investigated the impact of this risk factor in the group of older patients, especially octogenarians.Objectives: To compare in-hospital mortality and morbidity of diabetic and nondiabetic patients aged ≥ 80 years submitted to CABG.Methods: A total of 140 consecutive cases were studied, of whom 37 (26.4%) were diabetics, in a retrospective crosssectional study, that included all patients aged ≥ 80 years submitted to isolated/associated CABG. The patients' mean age was 82.5 ± 2.2 years and 55.7% were males.Results: The hospital mortality rate did not significantly differ in multivariate analysis: 16.2% diabetic x 13.6% nondiabetic (P = 0.554), as well as morbidity: 43.2% x 37.9%, respectively (P = 0.533). Regarding to operative morbidity, the occurrence of stroke was significantly higher in diabetic patients in the univariate analysis (10.8% x 1.9%, P = 0.042). In multivariate analysis, however, the incidence of stroke was not associated with the presence of diabetes (P = 0.085), but it was associated with atrial fibrillation (P = 0.044). There was no significant difference related to other complications.Conclusion: In this small consecutive retrospectively analyzed series, there was no significant increase in hospital mortality and morbidity related to diabetes for CABG in octogenarian patients. The impact of the results of this study is limited by the sample size and might be confirmed by future randomized clinical trials.Descriptors: Myocardial revascularization. Aged. Aged, 80 and over. Diabetes mellitus. ResumoIntrodução: O diabetes é um fator de risco conhecido para eventos adversos precoces e tardios em pacientes submetidos à cirurgia de revascularização miocárdica (CRM); entretanto, poucos estudos investigaram sua influência no grupo de pacientes mais idosos, especialmente nos octogenários.Objetivos: Comparar a mortalidade e a morbidade hospitalar de pacientes com idade ≥ 80 anos diabéticos e não-diabéticos submetidos à CRM. 601Rev Bras Cir Cardiovasc 2012;27(4):600-6 Pivatto Júnior F, et al. -Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?Métodos: Foram estudados 140 casos consecutivos, sendo 37 (26,4%) diabéticos, em um estudo transversal retrospectivo incluindo todos os pacientes com idade ≥ 80 anos submetidos à CRM isolada/associada. A idade média dos pacientes foi de 82,5 ± 2,2 anos e 55,7% eram do sexo masculino.Resultados: A taxa de mortalidade hospitalar não diferiu de maneira significativa na análise multivariada entre os grupos, 16,2% diabéticos x 13,6% não-diabéticos (P=0,554), assim como a morbidade pós-operatória, 43,2 x 37,9%, respectivamente (P=0,533). Em relação à morbidade, a ocorrência de acidente vascular cerebral foi significativamente maior em pacientes diabéticos na análise univariada (10,8% x 1,9%; P = 0,042). Na a...

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Fatores de risco para infecção de ferida esternal e aplicação do escore da STS em pacientes submetidos à cirurgia de revascularização miocárdica

Cited by 31 publications

References 30 publications

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Evaluation of the Society of Thoracic Surgeons score system for isolated coronary bypass graft surgery in a Brazilian population

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

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