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Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool

Magboo, R., Drey, N. ORCID: 0000-0003-0752-9049, Cooper, J. , Byers, H., Shipolini, A. & Sanders, J. (2020). Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool. Journal of clinical epidemiology, 128, pp. 57-65. doi: 10.1016/j.jclinepi.2020.08.015


Objective: To develop and validate a new risk tool (Barts Surgical Infection Risk (B-SIR)) to predict surgical site infection (SSI) risk after all types of adult cardiac surgery, and compare its predictive ability against existing (but procedure specific) tools: Brompton-Harefield Infection Score (BHIS), Australian Clinical Risk Index (ACRI), National Nosocomial Infection Surveillance (NNIS).

Design: Single-centre retrospective analysis of prospectively collected data.

Patients and Setting: Data from 2,449 patients undergoing cardiac surgery between January 2016 and December 2017 from one European tertiary centre were included.

Methods: Thirty-four variables associated with SSI risk after cardiac surgery, identified from the literature, were collated from three local databases. Independent predictors were identified using stepwise multivariate logistic regression. Bootstrap resampling was conducted to validate the model. Hosmer-Lemeshow goodness of fit test was performed to assess calibration of scores. A p-value of <0.05 was considered statistically significant for all analyses.

Results: The B-SIR model was constructed from six independent predictors (female gender, body mass index (BMI) >35, diabetes, left ventricular ejection fraction (LVEF) <45%, peripheral vascular disease (PVD) and operation type, and the risk estimates were derived. The Receiver Operating Characteristics curve for B-SIR was 0.679, vs 0.603 for BHIS, 0.618 for ACRI and 0.482 for the NNIS tool.

Conclusion: B-SIR provides greater predictive power of SSI risk after cardiac surgery compared with existing tools in our population. Further studies are needed to validate B-SIR on other cardiac populations and specific cardiac patient groups.

Publication Type: Article
Additional Information: © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Publisher Keywords: Surgical site infection, Cardiac surgery, Risk factor, Prediction tool, Stratification, Risk assessment
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
Departments: School of Health & Psychological Sciences > Nursing
[thumbnail of B-SIR manuscript v3.pdf]
Text - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

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