Clinical predictors of major infections after cardiac surgery.
BACKGROUND
Major infections are infrequent but important complications of cardiac surgery. Predicting their occurrence is essential for future prevention. The objective of the current investigation was to create and validate a bedside scoring system to estimate patient risk for major infection (mediastinitis, thoracotomy or vein harvest site infection, or septicemia) after coronary artery bypass grafting.


RESULTS
Using the Society of Thoracic Surgeons National Cardiac Database, we analyzed 331 429 coronary artery bypass grafting cases from January 1, 2002, to December 31, 2003, to identify risk factors for major infection. Using logistic regression, 2 models were generated and validated using split-sample validation: (1) One limited to preoperative characteristics (preop model) and (2) one model including both preoperative and intraoperative characteristics (combined model). Major infection occurred in 11 636 patients (3.51%) (25.1% mediastinitis, 32.6% saphenous harvest site, 35.0% septicemia, 0.5% thoracotomy, 6.8% multiple sites). Patients with major infection had significantly higher mortality (17.3% versus 3.0%, P<0.0001) and postoperative length of stay >14 days (47.0% versus 5.9%, P<0.0001) than patients without major infection. Both the preop model (c-index 0.697) and combined model (c-index: 0.708) successfully discriminated between high- and low-risk patients. A simplified risk scoring system of 12 variables accurately predicted risk for major infection.


CONCLUSIONS
We identified and validated a model that can identify patients undergoing cardiac surgery who are at high risk for major infection. These high-risk patients may be targeted for perioperative intervention strategies to reduce rates of major infection.
Fowler
Vance G
VG
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. fowle003@mc.duke.edu
O'Brien
Sean M
SM
Muhlbaier
Lawrence H
LH
Corey
G Ralph
GR
Ferguson
T Bruce
TB
Peterson
Eric D
ED
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D008480:Mediastinitis / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D014481:United States / Q000453:epidemiology