Performance of a novel risk model for deep sternal wound infection after coronary artery bypass grafting

Abstract

Clinical prediction models for deep sternal wound infections (DSWI) after coronary artery bypass graft (CABG) surgery exist, although they have a poor impact in external validation studies. We developed and validated a new predictive model for 30-day DSWI after CABG (REPINF) and compared it with the Society of Thoracic Surgeons model (STS). The REPINF model was created through a multicenter cohort of adults undergoing CABG surgery (REPLICCAR II Study) database, using least absolute shrinkage and selection operator (LASSO) logistic regression, internally and externally validated comparing discrimination, calibration in-the-large (CL), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), trained between the new model and the STS PredDeep, a validated model for DSWI after cardiac surgery. In the validation data, c-index = 0.83 (95% CI 0.72–0.95). Compared to the STS PredDeep, predictions improved by 6.5% (IDI). However, both STS and REPINF had limited calibration. Different populations require independent scoring systems to achieve the best predictive effect. The external validation of REPINF across multiple centers is an important quality improvement tool to generalize the model and to guide healthcare professionals in the prevention of DSWI after CABG surgery.

Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

“…The dichotomous variables were diabetes mellitus (DM), 1–3,8–21,23–32,34–54,56–66,68–79,103,106–109 female gender, 1–3,9–21,23,24,26–32,34,36–65,67–76,78–80,103–109 emergent/urgent procedures,…”

“…This leads to prolonged hospital stays, incremental charges and great suffering 6,7 . To determine its aetiology and minimize its incidence, we reviewed related studies and found that a large number of researches, 1–3,8–109 including retrospective matched or unmatched case‐control and cohort studies, have been conducted to study the risk factors among possible variables directly or indirectly, most of which were classified as preoperative or baseline, intraoperative and postoperative variables. Dozens of them have been proven to be significant in univariate or multivariate analyses, and the latter have been identified as independent risk factors of SWI.…”