Gatti et al evaluated patients for the risk of deep sternal wound infection (DSWI) following bilateral internal thoracic artery (BITA) grafting. They reported 2 predictive models, with one based on perioperative findings. The authors are from Ospedali Riuniti and University of Trieste in Italy.
Patient selection: CABG using bilateral internal thoracic artery grafts
Outcome: deep sternal wound infection (DSWI) and mediastinitis
Parameters:
(1) sex
(2) body mass index (BMI) in kilograms per square meter
(3) diabetes status
(4) glycemic control
(5) chronic lung disease
(6) surgical acuity
(7) use of chlorhexidine-alcohol
(8) porcelain aorta by intraoperative EAS (epiaortic ultrasonography scan)
(9) low cardiac output postoperatively
(10) number of red blood cell transfusions
(11) mediastinal re-exploration in the postoperative period
Parameter |
Finding |
Points |
sex |
male |
0 |
|
female |
66 |
BMI |
<= 30 |
0 |
|
> 30 |
24 |
diabetes |
none |
0 |
|
on oral hypoglycemic agent |
31 |
|
on insulin |
54 |
glycemic control |
good or fair |
0 |
|
poor |
46 |
chronic lung disease |
absent |
0 |
|
present |
62 |
surgical acuity |
elective |
0 |
|
urgent |
28 |
use of chlorhexidine-alcohol |
no |
0 |
|
yes |
51 |
porcelain aorta |
no |
0 |
|
yes |
36 |
low cardiac output |
no |
0 |
|
yes |
100 |
number of RBC transfusions |
<= 2 |
0 |
|
> 2 |
35 |
mediastinal re-exploration |
no |
0 |
|
yes |
39 |
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 541
• The higher the score the greater the risk for DSWI.
Total Score |
Risk DSWI |
< 127 |
< 10% |
127-154 |
10% |
155-175 |
15% |
176-192 |
20% |
193-207 |
25% |
208-221 |
30% |
222-233 |
35% |
234-246 |
40% |
247-258 |
45% |
259-270 |
50% |
271-282 |
55% |
283-295 |
60% |
296-308 |
65% |
>= 309 |
>= 70% |
Performance:
• The area under the ROC curve is 0.73.
Specialty: Infectious Diseases, Surgery, general