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.

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.

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

2019 ◽  
Vol 8 (4) ◽  
pp. 480 ◽  
Author(s):  
Juan Bustamante-Munguira ◽  
Francisco Herrera-Gómez ◽  
Miguel Ruiz-Álvarez ◽  
Ana Hernández-Aceituno ◽  
Angels Figuerola-Tejerina
Keyword(s):  
Cardiac Surgery ◽  
Surgical Site Infection ◽  
Risk Score ◽  
Artery Bypass ◽  
Characteristic Curve ◽  
Risk Index ◽  
Bypass Graft ◽  
Test Sample ◽  
Infection Risk ◽  
Site Infection

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.

Impact of Postdischarge Surveillance on Surgical-Site Infection Rates for Coronary Artery Bypass Procedures

2002 ◽  
Vol 23 (7) ◽  
pp. 364-367 ◽  
Author(s):  
Joan L Avato ◽  
Kwan Kew Lai
Keyword(s):  
Coronary Artery ◽  
Surgical Site Infection ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Surgical Site Infection Rate ◽  
Harvest Site

Objective:To assess the influence of postdischarge infection surveillance on risk-adjusted surgical-site infection rates for coronary artery bypass graft (CABG) procedures.Design:Prospective surveillance of surgical-site infections after CABG.Setting:Tertiary-care referral hospital.Methods:Data on surgical-site infections were collected for 1,324 CABG procedures during 27 months. They were risk adjusted and analyzed according to the surgical surveillance protocol of the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention, with and without postdischarge data.Results:Data were available for 96% of the patients. Of the 88 surgical-site infections, 28% were identified prior to discharge and 72% postdischarge. More chest than harvest-site infections were identified (46% vs 11%) prior to discharge, and more harvest-site than chest infections were identified in the outpatient setting (42% vs 14%). The surgical-site infection rate for patients stratified under risk index 1, calculated without postdischarge surveillance, was 2.9%; when compared with that of the NNIS System, the P value was .29. When postdischarge surveillance was included, the surgical-site infection rate was 4.9% and statistically significant when compared with that of the NNIS System (P = .007). For patients stratified under risk index 2, the rates with and without postdischarge surveillance were 11.7% and 10.0%, respectively; when compared with the NNIS System rates, the P values were .000008 and .0006, respectively.Conclusions:Only 28% of the surgical-site infections would have been detected if surveillance had been limited to hospital stay. Postdischarge surveillance identified more surgical-site infections among risk index 1 patients. Hospitals with comprehensive postdischarge surveillance after CABG procedures are likely to record higher surgical-site infection rates than those that do not perform such surveillance.

scholarly journals Risk of surgical site infection in patients undergoing orthopedic surgery

2011 ◽  
Vol 19 (6) ◽  
pp. 1362-1368 ◽  
Author(s):  
Flávia Falci Ercole ◽  
Lúcia Maciel Castro Franco ◽  
Tamara Gonçalves Rezende Macieira ◽  
Luísa Cristina Crespo Wenceslau ◽  
Helena Isabel Nascimento de Resende ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Descriptive Analysis ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Site Infection ◽  
Chi Square ◽  
Historical Cohort ◽  
Surgical Site Infection Incidence ◽  
Chi Square Test

This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and 2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. The incidence of surgical site infection was 1.8%. Potential surgical wound contamination, clinical conditions, time and type of surgical procedure were statistically associated with infection. Identifying the association between surgical site infection and these risk factors is important and contributes to nurses’ clinical practice.

Finding a Method for Optimizing Risk Adjustment When Comparing Surgical-Site Infection Rates

2004 ◽  
Vol 25 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Christian Brandt ◽  
Sonja Hansen ◽  
Dorit Sohr ◽  
Franz Daschner ◽  
Henning Rüden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Regression Models ◽  
Predictive Power ◽  
Risk Index ◽  
Significant Risk ◽  
Site Infection ◽  
Logistic Regression Models ◽  
System Risk

AbstractObjective:To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index.Design and Setting:The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations).Methods:For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models.Results:For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index.Conclusion:Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.

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.

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

2009 ◽  
Vol 30 (6) ◽  
pp. 563-569 ◽  
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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