A New Surgical Site Infection Risk Score: Infection Risk Index in Cardiac Surgery

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.

Prospective multicenter study on the incidence of surgical site infection after emergency abdominal surgery in China

“…Surgery-related variables included type of surgery based on surgical site (colorectal or non-colorectal), surgical wound class (clean-contaminated, contaminated, or dirty), methods of bowel preparation (mechanical bowel preparation [MBP] or oral antibiotic bowel preparation [OABP]), hand preparation (disinfectant or scrubbing), use of laparoscopy or robotic surgery, use of incisional protection devices (gauze, adhesive drapes, wound edge protector, or something else), grade of lead surgeon (based on their title), duration of surgery (from incision to suture), and the national nosocomial infections surveillance (NNIS) risk index. The NNIS risk index ranged from 0 to 3 per the assessment of three variables: ASA score, surgical wound class, and duration of surgery; the cutoff values for each variable were an ASA score of 3, a contaminated surgical incision, and an operative time of 180 min, with 1 point assigned when each variable exceeded its respective cutoff value 12 . Antibiotic-related variables included the use of preoperative and postoperative antibiotics.…”

Surgical Site Infection After Emergency Abdominal Surgery in China: A Multicenter Prospective Study

“…Surgery-related variables included type of surgery based on surgical site (colorectal or non-colorectal), surgical wound class (clean-contaminated, contaminated, or dirty), methods of bowel preparation (mechanical bowel preparation [MBP] or oral antibiotic bowel preparation [OABP]), hand preparation (disinfectant or scrubbing), use of laparoscopy or robotic surgery, use of incisional protection devices (gauze, adhesive drapes, wound edge protector, or something else), grade of lead surgeon (based on their title), duration of surgery (from incision to suture), and the national nosocomial infections surveillance (NNIS) risk index. The NNIS risk index ranged from 0 to 3 per the assessment of three variables: ASA score, surgical wound class, and duration of surgery; the cutoff values for each variable were an ASA score of 3, a contaminated surgical incision, and an operative time of 180 min, with 1 point assigned when each variable exceeded its respective cutoff value [12]. Antibioticrelated variables included the use of preoperative and postoperative antibiotics.…”

Complicaciones Postoperatorias De La Cirugía Cardíaca en Pacientes Adultos: Revisión Del Alcance

“…No mapeamento das complicações apareceram em realce às complicações infecciosas que estão entre as mais frequentes e foram citadas nos estudos analisados (17,18,22,24,(27)(28)(29)(30)(31)(34)(35)(36) . Elas destacam-se devido a sua gravidade.…”

“…Infecção respiratória e pneumonia (17,18,22,24,28,30,34,35) 8 38,10 Infecções de sítio cirúrgico (17,22,24,28,35,36) 6 28,57 Mediastinite (24, 27-29, 30, 31) 6 28,57 Infecção do trato urinário (22,24,28,(34)(35) 5 23,81 Infecção de corrente sanguínea (22,34) 2 9,52 Sepse (24,35) 2 9,52 Endocardite (28,35) 2 9,52 Neurológicas Acidente vascular encefálico (23-25, 28, 30, 34, 35, 37) 8 38,10 Delirium pós-operatório (20,34,36) 3 14,29 Alteração sensorial, motora ou de reflexos (28,34) 2 9,52 Convulsão (24) 1 4,76 Alteração do nível de consciência ou coma (28) 1 4,76 Cardiovasculares Sangramentos (18,24,29,(34)(35)(36) 6 28,57 Fibrilação Atrial (19,21,24,25,29) 5 23,81 Infarto agudo do miocárdio (28)(29)…”