Russo Philip L, Spelman Denis W
Victorian Nosocomial Infection Surveillance System Coordinating Centre, North Melbourne, Australia.
Infect Control Hosp Epidemiol. 2002 Jul;23(7):372-6. doi: 10.1086/502068.
To develop a new, simple, and practical risk index for patients undergoing coronary artery bypass graft (CABG) surgery, to develop a preoperative risk index that is predictive of surgical-site infection (SSI), and to compare the new risk indices with the National Nosocomial Infections Surveillance (NNIS) System risk index.
Potential risk factor and infection data were collected prospectively and analyzed by multivariate analysis. Two new risk indices were constructed and then compared with the NNIS System risk index for predictive power for SSI.
Alfred Hospital is a 350-bed, university-affiliated, tertiary-care referral center. The cardiothoracic unit performs approximately 650 CABG procedures per year.
All patients undergoing CABG surgery within the cardiothoracic unit at Alfred Hospital between December 1, 1996, and September 29, 2000, were included.
Potential risk factor data were complete for 2,345 patients. There were 199 SSIs. Obesity (odds ratio [OR], 1.78; 95% confidence interval [CI95], 1.24 to 2.55), peripheral or cerebrovascular disease (OR, 1.64; CI95, 1.16 to 2.33), insulin-dependent diabetes mellitus (OR, 2.29; CI95, 1.15 to 4.54), and a procedure lasting longer than 5 hours (OR, 1.75; CI95, 1.18 to 2.58) were identified as independent risk factors for SSI. With the use of a different combination of these risk factors, two risk indices were constructed and compared using the Goodman-Kruskal nonparametric correlation coefficient (G). kisk index B had the highest G value (0.3405; CI95, 0.2245 to 0.4565), compared with the NNIS System risk index G value (0.3142; CI95, 0.1462 to 0.4822). The G value for risk index A, constructed from preoperative variables only, was 0.3299 (CI9,, 0.2039 to 0.4559).
Two new risk indices have been developed. Both indices are as predictive as the NNIS System risk index. One of the new risk indices can also be applied preoperatively.
为接受冠状动脉搭桥术（CABG）的患者制定一种新的、简单且实用的风险指数，制定一种可预测手术部位感染（SSI）的术前风险指数，并将新的风险指数与国家医院感染监测（NNIS）系统风险指数进行比较。
前瞻性收集潜在风险因素和感染数据，并通过多变量分析进行分析。构建了两个新的风险指数，然后与NNIS系统风险指数比较其对SSI的预测能力。
阿尔弗雷德医院是一家拥有350张床位的大学附属医院及三级医疗转诊中心。心胸外科每年进行约650例CABG手术。
纳入1996年12月1日至2000年9月29日在阿尔弗雷德医院心胸外科接受CABG手术的所有患者。
2345例患者的潜在风险因素数据完整。发生199例SSI。肥胖（比值比[OR]，1.78；95%置信区间[CI95]，1.24至2.55）、外周或脑血管疾病（OR，1.64；CI95，1.16至2.33）、胰岛素依赖型糖尿病（OR，2.29；CI95，1.15至4.54）以及手术持续时间超过5小时（OR，1.75；CI95，1.18至2.58）被确定为SSI的独立风险因素。使用这些风险因素的不同组合，构建了两个风险指数，并使用古德曼-克鲁斯卡尔非参数相关系数（G）进行比较。风险指数B的G值最高（0.3405；CI95，0.2245至0.4565）相比之下，NNIS系统风险指数的G值为（0.3142；CI95，0.1462至0.4822）。仅由术前变量构建的风险指数A的G值为0.3299（CI9，0.2039至0.4559）。
已开发出两个新的风险指数。两个指数的预测能力与NNIS系统风险指数相当。其中一个新的风险指数也可在术前应用。
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