Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients

Tiveron, Marcos Gradim; Fiorelli, Alfredo Inácio; Mota, Eduardo Moeller; Mejía, Omar Asdrúbal Vilca; Brandão, Carlos Manuel de Almeida; Dallan, Luís Alberto Oliveira; Pomerantzeff, P; Stolf, Noedir A. G

doi:10.5935/1678-9741.20120035

Cited by 28 publications

(28 citation statements)

References 35 publications

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“…Despite our results, in another Brazilian study, published by Tiveron et al. [16] , diabetes was not found to be independently associated with mediastinitis among 2768 patients when it was adjusted for renal disease. On the other hand, Ledur et al [17] found diabetes to be independently associated with any infection after CABG (including DSWI) among 717 Brazilian patients.Another independent risk factor for DSWI in our study was smoking, being associated with 2.1 times more likely to present with DSWI compared with non-smokers.…”

Section: Discussioncontrasting

confidence: 99%

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Ferraz¹,

Soares²,

Miranda³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveDeep sternal wound infection following coronary artery bypass grafting is a serious complication associated with significant morbidity and mortality. Despite the substantial impact of deep sternal wound infection, there is a lack of specific risk stratification tools to predict this complication after coronary artery bypass grafting. This study was undertaken to develop a specific prognostic scoring system for the development of deep sternal wound infection that could risk-stratify patients undergoing coronary artery bypass grafting and be applied right after the surgical procedure.MethodsBetween March 2007 and August 2016, continuous, prospective surveillance data on deep sternal wound infection and a set of 27 variables of 1500 patients were collected. Using binary logistic regression analysis, we identified independent predictors of deep sternal wound infection. Initially we developed a predictive model in a subset of 500 patients. Dataset was expanded to other 1000 consecutive cases and a final model and risk score were derived. Calibration of the scores was performed using the Hosmer-Lemeshow test.ResultsThe model had area under Receiver Operating Characteristic (ROC) curve of 0.729 (0.821 for preliminary dataset). Baseline risk score incorporated independent predictors of deep sternal wound infection: obesity (P=0.046; OR 2.58; 95% CI 1.11-6.68), diabetes (P=0.046; OR 2.61; 95% CI 1.12-6.63), smoking (P=0.008; OR 2.10; 95% CI 1.12-4.67), pedicled internal thoracic artery (P=0.012; OR 5.11; 95% CI 1.42-18.40), and on-pump coronary artery bypass grafting (P=0.042; OR 2.20; 95% CI 1.13-5.81). A risk stratification system was, then, developed.ConclusionThis tool effectively predicts deep sternal wound infection risk at our center and may help with risk stratification in relation to public reporting and targeted prevention strategies in patients undergoing coronary artery bypass grafting.

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Section: Discussioncontrasting

confidence: 99%

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Ferraz¹,

Soares²,

Miranda³

et al. 2017

Braz J Cardiovasc Surg

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“…Most studies (c=0.70-0.76) [15,19,26], except one (c=0.54) [18], however, have found the EuroSCORE, EuroSCORE II and STS detect mediastinitis with statistical significance, although study numbers were greater at n=800-11,000. Predictors identified in the literature include diabetes, peripheral vascular disease, chronic respiratory disease and dialysis [25][26][27]. Strategies to reduce mediastinitis are very important especially in those at high risk and should be implemented, including antibiotic prophylaxis, strict perioperative glycaemic control and optimal skin preparation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Risk Scores for Prediction of Complications following Aortic Valve Replacement

Wang

Choi

Haydock

et al. 2015

Heart, Lung and Circulation

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“…These infections are considered as severe complications; with high rates of morbidity and mortality, between 14 and 47%, representing high costs to the health system 6 , 8 - 9 .…”

Section: Introductionmentioning

confidence: 99%

Surgical site infection in patients submitted to heart transplantation

Rodrigues

Ferretti-Rebustini

Poveda

2016

Rev. Latino-Am. Enfermagem

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Objectives: to analyze the occurrence and predisposing factors for surgical site infection in patients submitted to heart transplantation, evaluating the relationship between cases of infections and the variables related to the patient and the surgical procedure. Method: retrospective cohort study, with review of the medical records of patients older than 18 years submitted to heart transplantation. The correlation between variables was evaluated by using Fisher's exact test and Mann-Whitney-Wilcoxon test. Results: the sample consisted of 86 patients, predominantly men, with severe systemic disease, submitted to extensive preoperative hospitalizations. Signs of surgical site infection were observed in 9.3% of transplanted patients, with five (62.5%) superficial incisional, two (25%) deep and one (12.5%) case of organ/space infection. There was no statistically significant association between the variables related to the patient and the surgery. Conclusion: there was no association between the studied variables and the cases of surgical site infection, possibly due to the small number of cases of infection observed in the sample investigated.

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Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients

Abstract: Rev Bras Cir Cardiovasc 2012;27(2):203-10

Cited by 28 publications

References 35 publications

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital

Comparison of Risk Scores for Prediction of Complications following Aortic Valve Replacement

Surgical site infection in patients submitted to heart transplantation

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