February 6, 2018 – A novel prediction model for preventing major infections after cardiac surgery developed by DCRI faculty is being utilized globally by surgeons and researchers in broad clinical areas.
In 2005, DCRI researchers created and validated a novel bedside scoring system to estimate risk for major infection in patients undergoing cardiac surgery. Published in Circulation, the official journal of the American Heart Association, the paper is currently being used in research studies, clinical trials and various other therapeutic areas around the world.
Though infrequent, major infections can complicate cardiac surgery, especially after a median sternotomy, a type of surgical approach in which a long, vertical inline incision is made along the breastbone providing access to the thoracic cavity.
“In late 2004, we identified a link between the specific characteristics of patients, in particular, the bacteria they are infected with, and the likelihood of the development of mediastinitis, one of the most devastating complications of cardiac surgery,” said the DCRI’s Vance G. Fowler, MD, first author of the paper.
Fowler proposed using the Society of Thoracic Surgeons (STS) National Cardiac Database to single out patients more likely to acquire an infection following a median sternotomy, using operative characteristics that could be associated with identifying high risk for subsequent surgery.
“The operative characteristics were important because they could be identified preoperatively, which allowed surgeons and caretakers to potentially intervene and take necessary measures to reduce the risk of perioperative and postoperative infections,” said Fowler.
Established in 1989 to report surgical outcomes after cardiothoracic surgical procedures, the STS database captures clinical information from nearly two thirds of all US bypass procedures from more than half of all centers performing adult cardiac surgery.
Using the STS database, the researchers effectively created a model with a simple scoring system where specific characteristics were identified as ‘more’ or ‘less’ associated with risk. The risk score generated by the scoring system accurately identified high-risk patients who could benefit from targeted interventions to reduce the likelihood of serious infection after cardiac surgery.
“Because the STS database was so large, with rich detail captured on the preoperative and perioperative details of hundreds of thousands of patients, we were able to include a great deal of clinical details in the model scoring system,” said Fowler.
Since the model is not patented, it has been widely used all over world in research studies, clinical trials and in various therapeutic areas, the most recent being in the cardiothoracic surgery ICU at Hospital São João in Oporto, Portugal, the largest cardiothoracic surgery facility in the country.
The staff at Hospital São João is using Fowler’s scale for the prevention of wound complications resulting from infection after chest surgery. In accordance with the scale, the facility is using incisional negative pressure wound therapy in patients that present risk of infection.
According to Viviana Goncalves, a cardiothoracic surgery ICU nurse at Hospital São João, all major wards of cardiothoracic surgery in Portugal are using Fowler’s scale for prevention of infection. The hospital hopes to translate and validate the scale in Portugal to develop surgical protocols.
“Our investigation identified and validated several risk factors available to the clinician in the preoperative setting that are now being used internationally to identify patients at risk for major infection,” said Fowler.