title: Prospective validation of a predictive scoring system for deep sternal wound infection after routine bilateral internal thoracic artery grafting.
abstract: The Gatti score is a weighted scoring system based on risk factors for deep sternal wound infection (DSWI) that has been specifically created to predict DSWI risk after routine bilateral internal thoracic artery (BITA) grafting. It has not undergone an external validation. The aim of the present study was to perform this validation.
  
  
  
  BITA grafts were used as skeletonized conduits in 304 (90.7%) of 335 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution between January 2014 and July 2015. Baseline characteristics, operative data and immediate outcomes of every patient were prospectively collected in a computerized data registry. A score was assigned to each patient preoperatively. The goodness-of-fit and the discrimination power of both models, preoperative and combined, of the Gatti score were assessed with the Hosmer-Lemeshow test and the calculation of the area under the receiver-operating characteristic curve, respectively.
  
  
  
  Eighteen (5.9%) patients suffered from DSWI. Major differences were found between the original series whence the Gatti score has been derived and the present prospective series. The Gatti score goodness-of-fit was satisfactory for both the preoperative (P = 0.61) and the combined model (P = 0.81). The area under the receiver-operating characteristic curve was 0.82 (95% confidence interval: 0.72-0.91) for the preoperative model and 0.8 (95% confidence interval: 0.71-0.9) for the combined model.
  
  
  
  On the basis of the results of the present prospective study, the Gatti score has proved to be effective in predicting DSWI following BITA grafting despite some differences between the original and the present series of patients. More studies have to be performed in order to strengthen the evidence of this first external validation.
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy gius.gatti@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Division of Infective Diseases, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Arterial grafts; Coronary artery bypass grafts; Quality improvement; Sternal wound infection