Hussey et al reported the Sternal Wound Prediction Scale (SWIPS) for identifying a patient at risk for sternal infection following open heart surgery. The authors are from the University of North Carolina in Charlotte.
Patient selection: open heart surgery
Parameters:
(1) diabetes mellitus
(2) COPD
(3) preoperative stay in the ICU
(4) obesity (BMI > 30 kg per sq meter)
(5) age in years
(6) sex
(7) impaired immune response
(8) number of internal mammary arteries harvested
(9) operation time in hours
(10) re-exploration for bleeding
(11) cardiopulmonary bypass time in hours
(12) hypotension/hypoperfusion after surgery
(13) number of hours on ventilatory support after surgery
(14) pharmacologic support after surgery (vasopressors, other)
(15) postoperative CPR
(16) postoperative hypoxemia
(17) transfusion of banked blood
Preoperative items: 1 to 7
Intraoperative items: 8 to 11
Postoperative items: 12 to 17
|
Parameter |
Finding |
Points |
|
diabetes |
no |
0 |
|
|
non-insulin dependent |
7 |
|
|
insulin dependent |
9 |
|
COPD |
no |
0 |
|
|
yes |
6 |
|
preop stay in ICU |
no |
0 |
|
|
yes |
4 |
|
obesity |
no |
0 |
|
|
yes |
4 |
|
age in years |
<= 70 years |
0 |
|
|
> 70 years |
5 |
|
sex |
female |
0 |
|
|
male |
1 |
|
impaired immune response |
no |
0 |
|
|
yes |
8 |
|
number of IMA harvested |
none |
0 |
|
|
1 |
3 |
|
|
2 |
8 |
|
operation time |
<= 4 hours |
0 |
|
|
> 4 hours |
7 |
|
re-exploration |
no |
0 |
|
|
yes |
6 |
|
cardiopulmonary bypass |
<= 2 hours |
0 |
|
|
> 2 hours |
6 |
|
hypotension/hypoperfusion |
no |
0 |
|
|
yes |
7 |
|
ventilatory support |
<= 48 hours |
0 |
|
|
> 48 hours |
5 |
|
pharmacologic support |
no |
0 |
|
|
yes |
2 |
|
postoperative CPR |
no |
0 |
|
|
yes |
5 |
|
postoperative hypoxemia |
no |
0 |
|
|
yes |
4 |
|
transfusion |
no |
0 |
|
|
yes |
5 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 92
• A score >= 25 is associated with sternal infection.
Specialty: Infectious Diseases
