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Estimating the Risk of Mediastinitis After Isolated Coronary Artery Bypass Graft (CABG) Surgery Using the ACC/AHA Risk Score

Purpose: To estimate the risk of mediastinitis in a patient undergoing isolated coronary artery bypass graft (CABG) surgery based on the 2004 ACC/AHA risk score.

Description

The risk of mediastinitis following isolated coronary artery bypass graft (CABG) surgery can be estimated using preoperative factors. This can help identify a patient who may benefit from more care during and closer monitoring after surgery. The score was developed by the American College of Cardiology, the American Heart Association, the American Association of Thoracic Surgery and the Society of Thoracic Surgeons.


Parameters:

(1) age

(2) body mass index (BMI)

(3) diabetes

(4) COPD

(5) dialysis

(6) left ventricular ejection fraction (LVEF)

(7) timing of surgery

 

Parameter

Finding

Points

age of years

< 60 years

0

 

60 - 69 years

1

 

70 - 79 years

1.5

 

>= 80 years

2

body mass index

< 31 kg per square meter

0

 

31 - 36.9 kg per square meter

2

 

>= 37 kg per square meter

4.5

diabetes mellitus

absent

0

 

present

1.5

COPD

absent

0

 

present

2

dialysis

absent

0

 

present

3

LVEF

>= 40%

0

 

< 40%

1.5

timing of surgery

elective

0

 

urgent or emergency

2

 

total risk score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 16.5

• The higher the score the greater the risk of post-operative mediastinitis.

 

Total Score

Percent with Mediastinitis

0 or 1

0.3%

2

0.4%

3

0.5%

4

0.7%

5

0.9%

6

1.3%

7

1.7%

8

2.5%

9

3.2%

10

4.2%

11

5.6%

12

>= 7.3%

 


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Specialty

Objective

ICD-10