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.

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.

Validation of Coronary Artery Bypass Graft Surgical Site Infection Surveillance Data From a Statewide Surveillance System in Australia

2007 ◽  
Vol 28 (7) ◽  
pp. 812-817 ◽  
Author(s):  
N. Deborah Friedman ◽  
Philip L. Russo ◽  
Ann L. Bull ◽  
Michael J. Richards ◽  
Heath Kelly
Keyword(s):  
Coronary Artery ◽  
Medical Records ◽  
Surveillance System ◽  
Artery Bypass ◽  
Donor Site ◽  
Bypass Graft ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Infection Surveillance

Objective.To measure the accuracy and determine the positive predictive value (PPV) and negative predictive value (NPV) of data submitted to a statewide surveillance system for identifying surgical site infection (SSI) complicating coronary artery bypass graft (CABG) surgery.Design.Retrospective review of hospital medical records comparing SSI data with surveillance data submitted by infection control consultants (ICCs).Setting.Victorian Hospital Acquired Infection Surveillance System (VICNISS) Coordinating Centre in Victoria, Australia.Patients.All patients reported to have an SSI following CABG surgery and a random sample of approximately 10% of patients reported not to have an SSI following CABG surgery.Results.The VICNISS ascertainment rate for CABG procedures in Victoria was 95%. One hundred sixty-nine medical records were reviewed, and reviewers agreed with ICCs about 46 (96%) of the patients reported as infected by the ICCs and 31 (91%) of the patients identified with a sternal SSI by the ICCs. In one-third of SSIs, the depth of SSI documented by ICCs was discordant with that documented by the reviewers. Disagreement about patients with donor site SSI was frequent. When the review findings were used as the reference standard, the PPV for ICC-reported SSI was 96% (95% confidence interval [CI], 86%-99%), and the NPV was 97% (95% CI, 92%-99%). For ICC-reported sternal SSI, the PPV was 91% (95% CI, 76%-98%) and the NPV was 98% (95% CI, 94%-100%).Conclusions.There was broad agreement on the number of infected patients and the number of patients with sternal SSI. However, discordance was frequent with respect to the depth of sternal SSI and the identification of donor site SSI. We recommend modifications to the methodology for National Noscomial Infection Surveillance System-based surveillance for SSI following CABG surgery.

scholarly journals Increased Peak Postoperative B-type Natriuretic Peptide Predicts Decreased Longer-term Physical Function after Primary Coronary Artery Bypass Graft Surgery

2011 ◽  
Vol 114 (4) ◽  
pp. 807-816 ◽  
Author(s):  
Amanda A. Fox ◽  
Edward R. Marcantonio ◽  
Charles D. Collard ◽  
Mathis Thoma ◽  
Tjorvi E. Perry ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Short Form ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Effect Estimate ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Short Form 36

Background Increased peak postoperative B-type natriuretic peptide (BNP) is associated with increased major adverse cardiovascular events and all-cause mortality after coronary artery bypass graft (CABG) surgery. Whether increased postoperative BNP predicts worse postdischarge physical function (PF) is unknown. We hypothesized that peak postoperative BNP associates with PF assessed up to 2 yr after CABG surgery, even after adjusting for clinical risk factors. including preoperative PF. Methods This two-institution prospective cohort study included patients undergoing primary CABG surgery with cardiopulmonary bypass. Short Form-36 questionnaires were administered to subjects preoperatively and 6 months, 1 yr, and 2 yr postoperatively. Short Form-36 PF domain scores were calculated using the Short Form-36 norm-based scoring algorithm. Plasma BNP concentrations measured preoperatively and on postoperative days 1-5 were log(10) transformed before analysis. To determine whether peak postoperative BNP independently predicts PF scores 6 months through 2 yr after CABG surgery, multivariable longitudinal regression analysis of the postoperative PF scores was performed, adjusting for important clinical risk factors. Results A total of 845 subjects (mean ± SD age, 65 ± 10 yr) were analyzed. Peak postoperative BNP was significantly associated with postoperative PF (effect estimate for log(10) peak BNP, -7.66 PF score points [95% CI, -9.68 to -5.64]; P = &lt;0.0001). After multivariable adjustments, peak postoperative BNP remained independently associated with postoperative PF (effect estimate for log(10) peak BNP, -3.06 PF score points [95% CI, -5.15 to -0.97]; P = 0.004). Conclusions Increased peak postoperative BNP independently associates with worse longer-term PF after primary CABG surgery. Future studies are needed to determine whether medical management targeted toward reducing increased postoperative BNP can improve PF after CABG surgery.

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.

scholarly journals Prediction of Postoperative Pulmonary Complications on the Basis of Preoperative Risk Factors in Patients Who Had Undergone Coronary Artery Bypass Graft Surgery

2003 ◽  
Vol 83 (1) ◽  
pp. 8-16 ◽  
Author(s):  
Erik HJ Hulzebos ◽  
Nico LU Van Meeteren ◽  
Rob A De Bie ◽  
Pieter C Dagnelie ◽  
Paul JM Helders
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Pulmonary Complications ◽  
Artery Bypass Graft ◽  
Postoperative Pulmonary Complications ◽  
Preoperative Risk ◽  
Cabg Surgery ◽  
Preoperative Risk Factors

Abstract Background and Purpose. Pulmonary complications are among the most frequently reported complications after coronary artery bypass graft (CABG) surgery. However, the risks of postoperative pulmonary complications (PPCs) are not equal for all patients. The aim of this study was to develop a model, based on preoperative factors, for classifying patients with high and low risks for PPCs in order to implement tailored interventions. Subjects and Methods. Postoperative pulmonary complications were examined in 117 adult patients who had undergone elective CABG surgery at the University Medical Centre Utrecht, Utrecht, the Netherlands. The presence of preoperative risk factors (N=12) that have been described in the literature was noted for each patient. A risk model was developed by use of logistic regression analysis. Results. Preoperative risk factors for developing PPCs were an age of ≥70 years, productive cough, diabetes mellitus, and a history of cigarette smoking. Protective factors against the development of PPCs were a predicted inspiratory vital capacity of ≥75% and a predicted maximal expiratory pressure of ≥75%. These risk and protective factors were included in the model (sensitivity=87% and specificity=56%), and a sum score for its clinical use was generated. Discussion and Conclusion. Six factors that can be determined easily before surgery, with need for only simple pulmonary testing, can provide a model for identifying patients at risk of developing PPCs after CABG surgery.

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.

Risk factors for postoperative pulmonary complications in coronary artery bypass graft surgery patients

2007 ◽  
Vol 6 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Louise Jensen ◽  
Liyan Yang
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Pleural Effusion ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Pulmonary Complications ◽  
Artery Bypass Graft ◽  
Postoperative Pulmonary Complications ◽  
Cabg Surgery ◽  
History Of

Background Despite numerous advances in anesthesia, surgical techniques, and postoperative care for coronary artery bypass graft (CABG) surgery, postoperative pulmonary complications (PPCs) still account for postoperative morbidity. Objective To determine current risk factors for PPCs in CABG surgery patients. Methods A retrospective cohort design was used. Health records were reviewed for patients ( n=315) who had CABG surgery at a large quaternary healthcare center over a 4 month period. Pre-, peri-, and postoperative risk factors for PPCs were recorded as binary variables. Data were further assessed according to PPCs and non-PPCs using logistic regression models. Results PPCs occurred in 99.4% of this CABG surgical cohort. Atelectasis, pleural effusion, atelectasis with pleural effusion, and pneumonia were the most frequent PPCs post CABG surgery. Age >65 years, diabetes, and ASA classification N3 were found to be related to the presence of atelectasis. No significant risk factors were related to the development of pleural effusion or atelectasis with pleural effusion. Postoperative pneumonia was associated with previous myocardial infarction, ventilation >10 h, and hospital stay >5 days. History of bronchitis and COPD were related to postoperative pneumothorax; history of heart failure, COPD, and other lung diseases were related to postoperative pulmonary edema. Conclusion These findings contribute to the understanding of PPCs in post-CABG surgery patients and assist in identification of patients at risk for developing PPCs.

scholarly journals Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

2017 ◽  
Vol 8 (1) ◽  
pp. 200-207
Author(s):  
Sarah Farukhi Ahmed ◽  
Audrey Xi Tai ◽  
Mason Schmutz ◽  
John Combs ◽  
Sameh Mosaed
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Vision Loss ◽  
Artery Bypass ◽  
Venous Pressure ◽  
Bypass Graft ◽  
Ischemic Optic Neuropathy ◽  
Cabg Surgery ◽  
Ocular Hypotony

Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

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