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Risk Adjustment for Surgical Site Infection After Median Sternotomy in Children

Published online by Cambridge University Press:  02 January 2015

Jessica Kagen ,
Warren B. Bilker ,
Ebbing Lautenbach ,
Louis M. Bell ,
Susan E. Coffin ,
Keith H. St. John ,
Eva Teszner ,
Troy Dominguez ,
J. William Gaynor  and
Samir S. Shah
Jessica Kagen
Affiliation:
Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Centers for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Centers for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Louis M. Bell
Affiliation:
Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Infection Prevention and Control, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Keith H. St. John
Affiliation:
Department of Infection Prevention and Control, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Eva Teszner
Affiliation:
Department of Infection Prevention and Control, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Troy Dominguez
Affiliation:
Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
J. William Gaynor
Affiliation:
Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Samir S. Shah*
Affiliation:
Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Centers for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Division of Infectious Diseases, Room 1526, North Campus, the Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 (shahs@email.chop.edu)
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Abstract

Objective.

To determine whether the National Nosocomial Infections Surveillance (NNIS) System risk index adequately stratified a population of pediatric patients undergoing cardiac surgery according to the risk of developing surgical site infection (SSI).

Design.

A retrospective, case-control study.

Setting.

An urban tertiary care children's hospital.

Patients.

Patients who had a median sternotomy performed between January 1,1995, and December 31, 2003, were eligible for inclusion in the study. For all case patients, medical records were reviewed to verify that all patients met the case definition for SSI. Control subjects were chosen randomly from among all patients who underwent median sternotomy during the study period who did not develop SSI.

Results.

Thirty-eight patients with SSI and 172 patients without SSI were included. One hundred six patients (50%) were male. The median patient age was 4 months. The sensitivity of the NNIS risk index with cutoff scores of 0 to 1 and 2 to 3 was 20%. The distribution of patients with SSI for an NNIS risk index score of 0 was 0%; for a score of 1, 80%; for a score of 2, 20%; and for a score of 3, 0%. The distribution of patients without SSI for a scores of 0 was 4%; for a score of 1, 87%; for a score of 2, 9%; and for a score of 3, 0%. The area under the receiver-operating characteristic curve (AUC) of the original NNIS risk index was 0.57. The modified risk indices did not perform significantly better, with an AUC range of 0.58 to 0.73.

Conclusions.

The NNIS risk index did not adequately stratify pediatric patients undergoing median sternotomy according to their risk of developing an SSI. Various modifications to the risk index yielded only slightly higher AUC values.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 398 - 405
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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