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

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.

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Accounting for Incomplete Postdischarge Follow-Up During Surveillance of Surgical Site Infection by Use of the National Nosocomial Infections Surveillance System's Risk Index

Infection Control and Hospital Epidemiology ◽

10.1086/596732 ◽

2009 ◽

Vol 30 (5) ◽

pp. 433-439 ◽

Cited By ~ 6

Author(s):

Fernando Martín Biscione ◽

Renato Camargos Couto ◽

Tânia M. G. Pedrosa

Keyword(s):

Surgical Site Infection ◽

Nosocomial Infections ◽

Goodness Of Fit ◽

Risk Index ◽

Operative Procedures ◽

Site Infection ◽

Goodness Of Fit Test ◽

Simple Method ◽

Genitourinary System

Objective.We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index.Design.Retrospective cohort study that used data prospectively collected from 1993 through 2006.Setting.Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil.Patients.Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies, and 6,892 laparotomies.Methods.For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated.Results.The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations on the genitourinary system or after a cholecystectomy.Conclusions.Compared with the NNIS-based model, the modified NNIS-based model added potentially useful clinical information regarding most of the operative procedures. Further work is warranted to evaluate this method for accounting for incomplete postdischarge follow-up during surveillance of SSI.

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Validating a 3-Point Prediction Rule for Surgical Site Infection after Coronary Artery Bypass Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/649019 ◽

2010 ◽

Vol 31 (1) ◽

pp. 64-68 ◽

Cited By ~ 17

Author(s):

Luke F. Chen ◽

Deverick J. Anderson ◽

Keith S. Kaye ◽

Daniel J. Sexton

Keyword(s):

Coronary Artery ◽

Surgical Site Infection ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Risk Index ◽

The United States ◽

Site Infection ◽

Cabg Surgery ◽

Control Subjects ◽

Clinical Risk

Background.Surgical site infection (SSI) after coronary artery bypass graft (CABG) surgery is an increasing healthcare problem. Investigators from Australia proposed a new, 3-point scale that assesses SSI risk on the basis of diagnosis of diabetes mellitus and body mass index.Objective.To validate the Australian Clinical Risk Index among patients undergoing CABG surgery in the United States.Design and Setting.Nested case-control study involving patients undergoing CABG surgery at 9 hospitals during 1991-2002.Patients.Case patients were those who developed SSIs after CABG surgery. Control subjects were matched to case patients on the basis of hospital, age, and procedure date.Methods.Odds ratios (ORs) for SSIs were calculated for the comparison of case patients with control subjects for all risk categories determined using the Australian Clinical Risk Index and National Nosocomial Infections Surveillance System (NNIS) risk index. An adjusted area under the curve was used to compare predictive values among risk indices.Results.Four hundred sixty patients were studied, including 269 patients with SSI and 191 control subjects. NNIS risk group 2 was associated with increased rate of SSI (OR, 1.79; 95% confidence interval [CI], 1.19-2.67). No patient had an NNIS risk index of 3. The remaining NNIS categories were not predictive of infection. In contrast, an increase in Australian Clinical Risk Index was associated with an increase in risk of SSI (category 2: OR, 2.39 [95% CI, 1.33-4.29]; category 3: OR, 4.46 [95% CI, 1.83-10.85]).Conclusions.The NNIS risk index predicts the risk of SSI associated with many procedures, but it has limited use in predicting the risk of SSI after CABG surgery. The new Australian Clinical Risk Index stratified patients into discrete groups associated with increased risk of SSI. Data from our study support the use of this new risk index in the US population.

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Validation of a Modified Version of the National Nosocomial Infections Surveillance System Risk Index for Health Services Research

Infection Control and Hospital Epidemiology ◽

10.1086/597523 ◽

2009 ◽

Vol 30 (6) ◽

pp. 563-569 ◽

Cited By ~ 9

Author(s):

Nick Daneman ◽

Andrew E. Simor ◽

Donald A. Redelmeier

Keyword(s):

Surgical Site Infection ◽

Nosocomial Infections ◽

Surveillance System ◽

Elective Surgery ◽

Risk Index ◽

Surgical Site Infections ◽

Population Based ◽

Site Infection ◽

Services Research ◽

System Risk

Objective.To validate the National Nosocomial Infections Surveillance system risk index through administrative data to predict surgical site infections.Design.Retrospective cohort study.Setting.Population-based analysis in Ontario, Canada.Patients.All elderly patients who underwent elective surgery from April 1, 1992, through March 31, 2006 (n = 469,349).Methods.Data on procedural and patient outcomes were gathered from linked population-wide hospital discharge records and physician claims. The 75th percentile of surgical duration was estimated through anesthesiologist billing fees recorded in 15-minute increments; the American Society of Anesthesiology score of at least 3 out of 5 was estimated by diagnostic codes for severe systemic illness; and all surgeries were classified as clean or clean-contaminated because of their elective nature (thus, the maximum score on the modified index was 2).Results.A total of 147,216 surgeries (31%) had a score of 0;246,592 (53%) had a score of 1; and 75,541 (16%) had a score of 2 on the modified index. The 30-day risk of surgical site infection increased with each increment in the modified index (score of 0, 5.4%; score of 1, 8.0%; score of 2, 14.3%; P < .001). The association was evident for surgical site infection diagnosed during the index admission (score of 0, 2.0%; score of 1, 3.7%; score of 2, 8.9%; P < .001), as well as that associated with reoperation or death (score of 0, 0.04%; score of 1, 0.23%; score of 2, 0.73%; P < .001). The modified index predicted increases in surgical site infection risk within each of 11 surgical subgroups. In accord with past research, the modified index had modest discrimination (C statistic, 0.59), and the majority of surgical site infections (72%) occurred within lower risk strata.Conclusions.The modified index predicts surgical site infection in population-based analyses and is associated with incremental increases in risk.

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Surgical Site Infection (SSI) Rates in the United States, 1992–1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index

Clinical Infectious Diseases ◽

10.1086/321860 ◽

2001 ◽

Vol 33 (s2) ◽

pp. S69-S77 ◽

Cited By ~ 321

Author(s):

Robert P. Gaynes ◽

David H. Culver ◽

Teresa C. Horan ◽

Jonathan R. Edwards ◽

Chesley Richards ◽

...

Keyword(s):

United States ◽

Surgical Site Infection ◽

Nosocomial Infections ◽

Surveillance System ◽

Risk Index ◽

The United States ◽

Site Infection

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Local application of gentamicin-containing collagen implant in the prophylaxis and treatment of surgical site infection following cardiac surgery

International Journal of Surgery ◽

10.1016/j.ijsu.2012.05.018 ◽

2012 ◽

Vol 10 ◽

pp. S10-S14 ◽

Cited By ~ 13

Author(s):

Shahzad G. Raja

Keyword(s):

Cardiac Surgery ◽

Surgical Site Infection ◽

Local Application ◽

Site Infection ◽

Collagen Implant

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Characterization of children submitted to cardiac surgery that developed surgical site infection

ESTIMA Brazilian Journal of Enterostomal Therapy ◽

10.30886/estima.v18.888_in ◽

2020 ◽

Author(s):

Aurilene Lima da Silva ◽

Ticiana Bezerra Castro Pontes ◽

Maria Sinara Farias ◽

Maria José Matias Muniz Filha ◽

Solange Gurgel Alexandre ◽

...

Keyword(s):

Cardiac Surgery ◽

Surgical Site Infection ◽

Prophylactic Antibiotic ◽

Site Infection ◽

Skin Preparation ◽

Descriptive Research ◽

Care Processes ◽

The City ◽

Diagnosis Of Infection

Objective: Characterize the clinical and surgical profile of children undergoing cardiac surgery who developed surgical site infection in a public hospital in the city of Fortaleza, Ceará. Methods: Descriptive research with a quantitative approach, developed in a pediatric cardiology unit, with data collected from April to June 2018. The study sample consisted of 26 children with surgical wound infection in the year 2017. Results: There were none gender prevalence; the weight range varied from 3 to 6 kg (42.3%) and neonates had a prevalence of 38%. Corrective surgeries represented 88% of the total; the surgical time varied from 2 to 6 hours (38%); 70% of the children were submitted to cardiopulmonary bypass with the predominant time of 90 to 120 minutes (27%); the diagnosis of infection was made between 4 and 6 days after the procedure. There was prophylactic antibiotic coverage in 88% and skin preparation in 92% of children. Conclusion: Characterizing the clinical-surgical profile of children undergoing cardiac surgery becomes essential for decision-making in the care processes of nurses, emphasizing the findings as a basis for the development of strategies for the prevention of surgical site infection in this clientele.

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