Fowler et al reported scores for predicting major infection after cardiac surgery. These are based on the Society of Thoracic Surgeons (STS) National Cardiac Database. The authors are from Duke University and Louisiana State University.
Patient selection: coronary artery bypass graft (CABG), age >= 55 years
Outcome: major infection (deep sternal wound, thoracotomy surgical site infection, leg wound infection at harvest site, sepsis). Other infections not listed as outcomes.
Parameters:
(1) age in years >= 55 years
(2) body mass index (BMI) in kg per square meter
(3) diabetes
(4) renal failure
(5) congestive heart failure
(6) peripheral vascular disease
(7) sex
(8) chronic lung disease
(9) cardiogenic shock
(10) myocardial infarction
(11) concomitant surgery (cardiac or noncardiac)
|
Parameter |
Finding |
Points |
|
age |
|
MAX(0,INT(((age)-55)/5)) |
|
BMI |
<30 |
0 |
|
|
30 to 40 |
4 |
|
|
> 40 |
9 |
|
diabetes |
no |
0 |
|
|
yes |
3 |
|
renal failure |
no |
0 |
|
|
yes |
4 |
|
congestive heart failure |
no |
0 |
|
|
yes |
3 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
2 |
|
sex |
male |
0 |
|
|
female |
2 |
|
chronic lung disease |
no |
0 |
|
|
yes |
2 |
|
cardiogenic shock |
no |
0 |
|
|
yes |
6 |
|
myocardial infarction |
no |
0 |
|
|
yes |
2 |
|
concomitant surgery |
no |
0 |
|
|
yes |
4 |
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: around 46 (depends on age)
• The higher the score the greater the risk of major infection.
|
Score |
Risk Major Infection |
|
0 |
0.9% |
|
1 |
1% |
|
2 |
1.1% |
|
3 |
1.3% |
|
4 |
1.5% |
|
5 |
1.6% |
|
6 |
1.9% |
|
7 |
2.1% |
|
8 |
2.4% |
|
9 |
2.7% |
|
10 |
3.1% |
|
11 |
3.5% |
|
12 |
4.0% |
|
13 |
4.5% |
|
14 |
5.1% |
|
15 |
5.8% |
|
16 |
6.6% |
|
17 |
7.4% |
|
18 |
8.2% |
|
19 |
9.1% |
|
20 |
9.9% |
|
21 |
10.7% |
|
22 |
11.4% |
|
23 |
12.1% |
|
24 |
12.9% |
|
25 |
13.6% |
|
26+ |
16% |
Performance:
•The area under the ROC curve is 0.70.
Specialty: Infectious Diseases, Surgery, general
