Clinical predictors of major infections after cardiac surgery
Major infections are infrequent but important complications of cardiac surgery. Predicting their occurrence is essential for future prevention. The objective of the current investigation was to create and validate a bedside scoring system to estimate patient risk for major infection (mediastinitis,...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2005-08, Vol.112 (9), p.I358-I365 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | FOWLER, Vance G O'BRIEN, Sean M MUHLBAIER, Lawrence H COREY, G. Ralph FERGUSON, T. Bruce PETERSON, Eric D |
| description | Major infections are infrequent but important complications of cardiac surgery. Predicting their occurrence is essential for future prevention. The objective of the current investigation was to create and validate a bedside scoring system to estimate patient risk for major infection (mediastinitis, thoracotomy or vein harvest site infection, or septicemia) after coronary artery bypass grafting.
Using the Society of Thoracic Surgeons National Cardiac Database, we analyzed 331 429 coronary artery bypass grafting cases from January 1, 2002, to December 31, 2003, to identify risk factors for major infection. Using logistic regression, 2 models were generated and validated using split-sample validation: (1) One limited to preoperative characteristics (preop model) and (2) one model including both preoperative and intraoperative characteristics (combined model). Major infection occurred in 11 636 patients (3.51%) (25.1% mediastinitis, 32.6% saphenous harvest site, 35.0% septicemia, 0.5% thoracotomy, 6.8% multiple sites). Patients with major infection had significantly higher mortality (17.3% versus 3.0%, P14 days (47.0% versus 5.9%, P |
| doi_str_mv | 10.1161/circulationaha.104.525790 |
| format | Article |
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Using the Society of Thoracic Surgeons National Cardiac Database, we analyzed 331 429 coronary artery bypass grafting cases from January 1, 2002, to December 31, 2003, to identify risk factors for major infection. Using logistic regression, 2 models were generated and validated using split-sample validation: (1) One limited to preoperative characteristics (preop model) and (2) one model including both preoperative and intraoperative characteristics (combined model). Major infection occurred in 11 636 patients (3.51%) (25.1% mediastinitis, 32.6% saphenous harvest site, 35.0% septicemia, 0.5% thoracotomy, 6.8% multiple sites). Patients with major infection had significantly higher mortality (17.3% versus 3.0%, P<0.0001) and postoperative length of stay >14 days (47.0% versus 5.9%, P<0.0001) than patients without major infection. Both the preop model (c-index 0.697) and combined model (c-index: 0.708) successfully discriminated between high- and low-risk patients. A simplified risk scoring system of 12 variables accurately predicted risk for major infection.
We identified and validated a model that can identify patients undergoing cardiac surgery who are at high risk for major infection. These high-risk patients may be targeted for perioperative intervention strategies to reduce rates of major infection.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circulationaha.104.525790</identifier><identifier>PMID: 16159846</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiac Surgical Procedures - statistics & numerical data ; Cardiology. Vascular system ; Databases, Factual ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Heart ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Infection - epidemiology ; Intra-Aortic Balloon Pumping - statistics & numerical data ; Intraoperative Period ; Logistic Models ; Male ; Mediastinitis - epidemiology ; Medical sciences ; Middle Aged ; Models, Theoretical ; Postoperative Complications - epidemiology ; Risk Factors ; Sepsis - epidemiology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgical Wound Infection - epidemiology ; Tissue and Organ Harvesting - adverse effects ; United States - epidemiology ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>Circulation (New York, N.Y.), 2005-08, Vol.112 (9), p.I358-I365</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-d76681506bb0d6e9c94bce14de2aba34a974bd8cb6c0e92822a0f5ee2f5098a13</citedby><cites>FETCH-LOGICAL-c511t-d76681506bb0d6e9c94bce14de2aba34a974bd8cb6c0e92822a0f5ee2f5098a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17191040$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16159846$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FOWLER, Vance G</creatorcontrib><creatorcontrib>O'BRIEN, Sean M</creatorcontrib><creatorcontrib>MUHLBAIER, Lawrence H</creatorcontrib><creatorcontrib>COREY, G. Ralph</creatorcontrib><creatorcontrib>FERGUSON, T. Bruce</creatorcontrib><creatorcontrib>PETERSON, Eric D</creatorcontrib><title>Clinical predictors of major infections after cardiac surgery</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Major infections are infrequent but important complications of cardiac surgery. Predicting their occurrence is essential for future prevention. The objective of the current investigation was to create and validate a bedside scoring system to estimate patient risk for major infection (mediastinitis, thoracotomy or vein harvest site infection, or septicemia) after coronary artery bypass grafting.
Using the Society of Thoracic Surgeons National Cardiac Database, we analyzed 331 429 coronary artery bypass grafting cases from January 1, 2002, to December 31, 2003, to identify risk factors for major infection. Using logistic regression, 2 models were generated and validated using split-sample validation: (1) One limited to preoperative characteristics (preop model) and (2) one model including both preoperative and intraoperative characteristics (combined model). Major infection occurred in 11 636 patients (3.51%) (25.1% mediastinitis, 32.6% saphenous harvest site, 35.0% septicemia, 0.5% thoracotomy, 6.8% multiple sites). Patients with major infection had significantly higher mortality (17.3% versus 3.0%, P<0.0001) and postoperative length of stay >14 days (47.0% versus 5.9%, P<0.0001) than patients without major infection. Both the preop model (c-index 0.697) and combined model (c-index: 0.708) successfully discriminated between high- and low-risk patients. A simplified risk scoring system of 12 variables accurately predicted risk for major infection.
We identified and validated a model that can identify patients undergoing cardiac surgery who are at high risk for major infection. These high-risk patients may be targeted for perioperative intervention strategies to reduce rates of major infection.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiac Surgical Procedures - statistics & numerical data</subject><subject>Cardiology. Vascular system</subject><subject>Databases, Factual</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Heart</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Infection - epidemiology</subject><subject>Intra-Aortic Balloon Pumping - statistics & numerical data</subject><subject>Intraoperative Period</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Mediastinitis - epidemiology</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Theoretical</subject><subject>Postoperative Complications - epidemiology</subject><subject>Risk Factors</subject><subject>Sepsis - epidemiology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Tissue and Organ Harvesting - adverse effects</subject><subject>United States - epidemiology</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF1LwzAUhoMobk7_gtQLvetM0iRtLrwYRd1gOJDtupymiWb0Yybtxf69GSvs6nAOz_seeBB6InhOiCCvyjo11NDbroVfmBPM5pzyVOIrNCWcspjxRF6jKcZYxmlC6QTdeb8Pq0hSfosmoYTLjIkpestr21oFdXRwurKq75yPOhM1sO9cZFuj1emNj8D02kUKXGVBRX5wP9od79GNgdrrh3HO0O7jfZsv4_Xmc5Uv1rHihPRxlQqREY5FWeJKaKkkK5UmrNIUSkgYyJSVVaZKobCWNKMUsOFaU8OxzIAkM_Ry7j247m_Qvi8a65Wua2h1N_hCZDzFjLIAyjOoXOe906Y4ONuAOxYEFyd3Rb76znfrxXa1-VosF-HMirO7kH0cnwxlo6tLcpQVgOcRAB-MGQetsv7CpUSGOpz8A6qUexg</recordid><startdate>20050830</startdate><enddate>20050830</enddate><creator>FOWLER, Vance G</creator><creator>O'BRIEN, Sean M</creator><creator>MUHLBAIER, Lawrence H</creator><creator>COREY, G. Ralph</creator><creator>FERGUSON, T. Bruce</creator><creator>PETERSON, Eric D</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050830</creationdate><title>Clinical predictors of major infections after cardiac surgery</title><author>FOWLER, Vance G ; O'BRIEN, Sean M ; MUHLBAIER, Lawrence H ; COREY, G. Ralph ; FERGUSON, T. Bruce ; PETERSON, Eric D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-d76681506bb0d6e9c94bce14de2aba34a974bd8cb6c0e92822a0f5ee2f5098a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiac Surgical Procedures - statistics & numerical data</topic><topic>Cardiology. Vascular system</topic><topic>Databases, Factual</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Heart</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Infection - epidemiology</topic><topic>Intra-Aortic Balloon Pumping - statistics & numerical data</topic><topic>Intraoperative Period</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Mediastinitis - epidemiology</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Theoretical</topic><topic>Postoperative Complications - epidemiology</topic><topic>Risk Factors</topic><topic>Sepsis - epidemiology</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Tissue and Organ Harvesting - adverse effects</topic><topic>United States - epidemiology</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FOWLER, Vance G</creatorcontrib><creatorcontrib>O'BRIEN, Sean M</creatorcontrib><creatorcontrib>MUHLBAIER, Lawrence H</creatorcontrib><creatorcontrib>COREY, G. Ralph</creatorcontrib><creatorcontrib>FERGUSON, T. Bruce</creatorcontrib><creatorcontrib>PETERSON, Eric D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FOWLER, Vance G</au><au>O'BRIEN, Sean M</au><au>MUHLBAIER, Lawrence H</au><au>COREY, G. Ralph</au><au>FERGUSON, T. Bruce</au><au>PETERSON, Eric D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical predictors of major infections after cardiac surgery</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2005-08-30</date><risdate>2005</risdate><volume>112</volume><issue>9</issue><spage>I358</spage><epage>I365</epage><pages>I358-I365</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Major infections are infrequent but important complications of cardiac surgery. Predicting their occurrence is essential for future prevention. The objective of the current investigation was to create and validate a bedside scoring system to estimate patient risk for major infection (mediastinitis, thoracotomy or vein harvest site infection, or septicemia) after coronary artery bypass grafting.
Using the Society of Thoracic Surgeons National Cardiac Database, we analyzed 331 429 coronary artery bypass grafting cases from January 1, 2002, to December 31, 2003, to identify risk factors for major infection. Using logistic regression, 2 models were generated and validated using split-sample validation: (1) One limited to preoperative characteristics (preop model) and (2) one model including both preoperative and intraoperative characteristics (combined model). Major infection occurred in 11 636 patients (3.51%) (25.1% mediastinitis, 32.6% saphenous harvest site, 35.0% septicemia, 0.5% thoracotomy, 6.8% multiple sites). Patients with major infection had significantly higher mortality (17.3% versus 3.0%, P<0.0001) and postoperative length of stay >14 days (47.0% versus 5.9%, P<0.0001) than patients without major infection. Both the preop model (c-index 0.697) and combined model (c-index: 0.708) successfully discriminated between high- and low-risk patients. A simplified risk scoring system of 12 variables accurately predicted risk for major infection.
We identified and validated a model that can identify patients undergoing cardiac surgery who are at high risk for major infection. These high-risk patients may be targeted for perioperative intervention strategies to reduce rates of major infection.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16159846</pmid><doi>10.1161/circulationaha.104.525790</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Aged Aged, 80 and over Biological and medical sciences Blood and lymphatic vessels Cardiac Surgical Procedures - statistics & numerical data Cardiology. Vascular system Databases, Factual Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Heart Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Infection - epidemiology Intra-Aortic Balloon Pumping - statistics & numerical data Intraoperative Period Logistic Models Male Mediastinitis - epidemiology Medical sciences Middle Aged Models, Theoretical Postoperative Complications - epidemiology Risk Factors Sepsis - epidemiology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgical Wound Infection - epidemiology Tissue and Organ Harvesting - adverse effects United States - epidemiology Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Clinical predictors of major infections after cardiac surgery |
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