A New Surgical-Site Infection Risk Index Using Risk Factors Identified by Multivariate Analysis for Patients Undergoing Coronary Artery Bypass Graft Surgery

2002 ◽  
Vol 23 (7) ◽  
pp. 372-376 ◽  
Author(s):  
Philip L. Russo ◽  
Denis W. Spelman
Keyword(s):  
Risk Factors ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Risk Indices ◽  
Alfred Hospital ◽  
System Risk ◽  
G Value

Objectives:To develop a new, simple, and practical risk index for patients undergoing coronary artery bypass graft (CABG) surgery, to develop a preoperative risk index that is predictive of surgical-site infection (SSI), and to compare the new risk indices with the National Nosocomial Infections Surveillance (NNIS) System risk index.Design:Potential risk factor and infection data were collected prospectively and analyzed by multivariate analysis. Two new risk indices were constructed and then compared with the NNIS System risk index for predictive power for SSI.Setting:Alfred Hospital is a 350-bed, university-affiliated, tertiary-care referral center. The cardiothoracic unit performs approximately 650 CABG procedures per year.Patients:All patients undergoing CABG surgery within the cardiothoracic unit at Alfred Hospital between December 1, 1996, and September 29, 2000, were included.Results:Potential risk factor data were complete for 2,345 patients. There were 199 SSIs. Obesity (odds ratio [OR], 1.78; 95% confidence interval [CI95], 1.24 to 2.55), peripheral or cerebrovascular disease (OR, 1.64; CI95, 1.16 to 2.33), insulin-dependent diabetes mellitus (OR, 2.29; CI95, 1.15 to 4.54), and a procedure lasting longer than 5 hours (OR, 1.75; CI95,1.18 to 2.58) were identified as independent risk factors for SSI. With the use of a different combination of these risk factors, two risk indices were constructed and compared using the Goodman-Kruskal nonparametric correlation coefficient (G). Risk index B had the highest G value (0.3405; CI95, 0.2245 to 0.4565), compared with the NNIS System risk index G value (0.3142; CI95, 0.1462 to 0.4822). The G value for risk index A constructed from preoperative variables only, was 0.3299 (CI95 0.2039 to 0.4559).Conclusion:Two new risk indices have been developed. Both indices are as predictive as the NNIS System risk index. One of the new risk indices can also be applied preoperatively.

Surgical-Site Infection After Cardiac Surgery: Incidence, Microbiology, and risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 466-472 ◽  
Author(s):  
Didier Lepelletier ◽  
Stéphanie Perron ◽  
Philippe Bizouarn ◽  
Jocelyne Caillon ◽  
Henri Drugeon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Site Infection ◽  
Internal Mammary ◽  
System Risk

AbstractObjective:To identify risk factors associated with surgical-site infection according to the depth of infection, the cardiac procedure, and the National Nosocomial Infections Surveillance System risk index.Design:Prospective survey conducted during a 12-month period.Setting:A 48-bed cardiac surgical department in a teaching hospital.Patients:Patients admitted for cardiac surgery between February 2002 and January 2003.Results:Surgical-site infections were diagnosed in 3% of the patients (38 of 1,268). Of the 38 surgical-site infections, 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6% and 1.4%, respectively. Cultures were positive in 28 cases and the most commonly isolated pathogen wasStaphylococcus. A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection (relative risk, 2.4;P< .004). Heart transplantation, mechanical circulatory assistance, coronary artery bypass graft with the use of internal mammary artery, and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection.Conclusions:Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts. Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis. Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection, and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection.

Risk Factors for Radial Artery Harvest Site Infection Following Coronary Artery Bypass Graft Surgery

2000 ◽  
Vol 30 (2) ◽  
pp. 270-275 ◽  
Author(s):  
William E. Trick ◽  
William E. Scheckler ◽  
Jerome I. Tokars ◽  
Kevin C. Jones ◽  
Ellen M. Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Radial Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Harvest Site

Surgical-Site Infection Rates and Risk Factor Analysis in Coronary Artery Bypass Graft Surgery

2004 ◽  
Vol 25 (6) ◽  
pp. 472-476 ◽  
Author(s):  
Glenys Harrington ◽  
Philip Russo ◽  
Denis Spelman ◽  
Sue Borrell ◽  
Kerrie Watson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Public Hospitals ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Cabg Surgery

AbstractBackground:The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery.Objective:To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group.Method:Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected.Results:For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia colt) from 18%, and miscellaneous organisms from the remainder.Conclusion:We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.

An Alternative Scoring System to Predict Risk for Surgical Site Infection Complicating Coronary Artery Bypass Graft Surgery

2007 ◽  
Vol 28 (10) ◽  
pp. 1162-1168 ◽  
Author(s):  
N. Deborah Friedman ◽  
Ann L. Bull ◽  
Philip L. Russo ◽  
Karin Leder ◽  
Christopher Reid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Scoring System ◽  
Surveillance System ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
New Scoring ◽  
Preoperative Factors

Objective.To analyze the risk factors for surgical site infection (SSI) complicating coronary artery bypass graft (CABG) surgery and to create an alternative SSI risk score based on the results of multivariate analysis.Methods.A prospective cohort study involving inpatient and laboratory-based surveillance of patients who underwent CABG surgery over a 27-month period from January 1, 2003 through March 31, 2005. Data were obtained from 6 acute care hospitals in Victoria, Australia, that contributed surveillance data for SSI complicating CABG surgery to the Victorian Hospital Acquired Infection Surveillance System Coordinating Centre and the Australasian Society of Cardiac and Thoracic Surgeons, also in Victoria.Results.A total of 4,633 (93%) of the 4,987 patients who underwent CABG surgery during this period were matched in the 2 systems databases. There were 286 SSIs and 62 deep or organ space sternal SSIs (deep or organ space sternal SSI rate, 1.33%). Univariate analysis revealed that diabetes mellitus, body mass index (BMI) greater than 35, and receipt of blood transfusion were risk factors for all types of SSI complicating CABG surgery. Six multivariate analysis models were created to examine either preoperative factors alone or preoperative factors combined with operative factors. All models revealed diabetes and BMI of 30 or greater as risk factors for SSI complicating CABG surgery. A new preoperative scoring system was devised to predict sternal SSI, which assigned 1 point for diabetes, 1 point for BMI of 30 or greater but less than 35, and 2 points for BMI of 35 or greater. Each point in the scoring system represented approximately a doubling of risk of SSI. The new scoring system performed better than the National Nosocomial Infections Surveillance System (NNIS) risk index at predicting SSI.Conclusion.A new weighted scoring system based on preoperative risk factors was created to predict sternal SSI risk following CABG surgery. The new scoring system outperformed the NNIS risk index. Future studies are needed to validate this scoring system.

Increase in the Rate of Sternal Surgical Site Infection After Coronary Artery Bypass Graft: A Marker of Higher Severity of Illness

2007 ◽  
Vol 28 (6) ◽  
pp. 655-660 ◽  
Author(s):  
Mohamad G. Fakih ◽  
Mamta Sharma ◽  
Riad Khatib ◽  
Dorine Berriel-Cass ◽  
Susan Meisner ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Severity Of Illness ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Peripheral Vascular ◽  
Duration Of Surgery

Objective.To evaluate factors related to a gradual rise in sternal surgical site infection (SSI) rates.Design.Retrospective cohort study.Setting.A 608-bed, tertiary care teaching hospital.Patients.All patients who underwent coronary artery bypass graft (CABG) from January 2000 through September 2004.Results.Of 3,578 patients who underwent CABG, 144 (4%) had sternal SSI. There was an increase in infection rate, with a marked reduction in the number of operations per year. The percentage of patients with peripheral vascular disease increased from 12% to 24.3% (P < .001), and the percentage with congestive heart failure increased from 17% to 22% (P < .001). Between 2002 and 2004, the mean duration of surgery increased from 233 to 290 minutes (P < .001), the percentage of patients with a National Nosocomial Infections Surveillance System (NNIS) risk index of 2 increased from 14.3% to 38% (P < .001), and the percentage of patients with a postoperative stay in the intensive care unit of greater than 72 hours increased from 29% to 40.6% (P < .001). Multivariate analysis showed diabetes mellitus, peripheral vascular disease, obesity, duration of surgery, and postoperative stay in the intensive care unit of greater than 72 hours to be independently associated with infection.Conclusions.An increase in infection in the CABG population not associated with an outbreak may be a reflection of a change in the severity of illness. Preoperative, intraoperative, and postoperative markers for increased infection risk may be used, in addition to the NNIS risk index, to assess the patient population risk.

Improved Risk Adjustment in Public Reporting: Coronary Artery Bypass Graft Surgical Site Infections

2012 ◽  
Vol 33 (5) ◽  
pp. 463-469 ◽  
Author(s):  
Sandra I. Berríos-Torres ◽  
Yi Mu ◽  
Jonathan R. Edwards ◽  
Teresa C. Horan ◽  
Scott K. Fridkin
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Model ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Surgical Site Infections ◽  
Predictive Performance ◽  
Public Reporting ◽  
Artery Bypass Graft

Objective.The objective was to develop a new National Healthcare Safety Network (NHSN) risk model for sternal, deep incisional, and organ/space (complex) surgical site infections (SSIs) following coronary artery bypass graft (CABG) procedures, detected on admission and readmission, consistent with public reporting requirements.Patients and Setting.A total of 133,503 CABG procedures with 4,008 associated complex SSIs reported by 293 NHSN hospitals in the United States.Methods.CABG procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Potential SSI risk factors were identified by univariate analysis. Multivariate analysis with forward stepwise logistic regression modeling was used to develop the new model. The c-index was used to compare the predictive power of the new and NHSN risk index models.Results.Multivariate analysis independent risk factors included ASA score, procedure duration, female gender, age, and medical school affiliation. The new risk model has significantly improved predictive performance over the NHSN risk index (c-index, 0.62 and 0.56, respectively).Conclusions.Traditionally, the NHSN surveillance system has used a risk index to provide procedure-specific risk-stratified SSI rates to hospitals. A new CABG sternal, complex SSI risk model developed by multivariate analysis has improved predictive performance over the traditional NHSN risk index and is being considered for endorsement as a measure for public reporting.

Admission-Specific Chronic Disease Scores as Alternative Predictors of Surgical Site Infection for Patients Undergoing Coronary Artery Bypass Graft Surgery

2006 ◽  
Vol 27 (08) ◽  
pp. 802-808 ◽  
Author(s):  
Ruth Batista ◽  
Keith Kaye ◽  
Deborah S. Yokoe
Keyword(s):  
Chronic Disease ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Disease Score ◽  
Chronic Disease Score ◽  
Study Participants

Objective.To evaluate the admission chronic disease score (ACDS) and a variant of the ACDS as predictors of surgical site infection (SSI) for study participants who underwent coronary artery bypass graft (CABG) surgery.Design.Retrospective case-control study.Setting.A 750-bed academic medical center.Participants.All participants with an SSI that was identified through hospital-based surveillance (defined as case patients) and a random sample of participants without SSI following CABG surgery (defined as control subjects) between July 1, 1999, and June 30, 2001.Results.An ACDS based on medications ordered on the day of hospital admission was determined for 264 study participants admitted prior to the day of the surgical procedure. A preadmission chronic disease score (PACDS) based on outpatient medications was calculated for 281 participants, using the record of preadmission medications in the patient's discharge summary. The ACDS and PACDS were significantly higher for case patients, compared with control subjects (P= .03 andP= .05, respectively). American Society of Anesthesiologists (ASA) score and the standard National Nosocomial Infection Surveillance system (NNIS) risk index were not significant predictors of SSI. In logistic regression models, only the ACDS (odds ratio, 1.02 per 100 ACDS points), the PACDS (odds ratio, 1.02 per 100 PACDS points), the highest PACDS quintile (odds ratio, 2.89 [compared with lowest quintile]), and a modified NNIS-PACDS score of 2 (odds ratio, 3.5 [compared with a score of 0]) were significant predictors of SSI.Conclusions.Because preoperative medications are likely to reflect comorbidities that influence the risk of SSI, medication-based scoring systems such as the ACDS and PACDS may allow for better risk stratification than the standard NNIS risk index, particularly for patient populations with relatively homogenous wound classification and ASA score distributions.

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