Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index

Abstract

Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

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

“…The NNIS risk index fails to present an effective discriminative capacity for patients undergoing cardiac surgery because these patients are highly similar to other operated patients [16]. Indeed, most cardiac surgery procedures are clean surgeries, and the ASA score is generally high, so the NNIS risk index is only capable of categorizing patients into two groups, those with more than 75P duration of surgery and those with 75P duration of surgery or less.…”

“…Consequently, the NNIS risk index score ranges from 0 (the lowest SSI risk) to 3 (the highest risk). However, although 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].…”

“…It assigns 1 point to DM diagnosis, 1 point if BMI is 30–34.9, and 2 points if BMI is 35 kg/m 2 or more. ACRI offers an improved risk estimation compared to the NNIS risk index [17], and it has been validated in both the United States [18] and recently by our European population group [16]. Although its discrimination falls significantly for patients undergoing valve replacement, other factors should be taken into account [16,18].…”

Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool

“…While we found the ACRI and BHIS models demonstrated good predictive power of SSI development, we concurred with other studies identifying that NNIS is a poor predictor of SSI after cardiac surgery. 13 21 Both the ACRI and BHIS models were validated in procedure-specific populations (valve 21 and CABG, 22 respectively) which may be why they performed less well than the B-SIR tool which was developed specifically to include patients undergoing various forms of cardiac surgery. This can also suggests that risk profile assessment varies based on the institutions' patient population as previously identified.…”

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“…10% cases we found contaminated/dirty wound which probably clean in initial stage. About 20% cases wound was clean -contaminated [12][13][14][15][16] (Table 1). During observation and taking history, we find some reasons foe contaminated and dirty wound.…”