Admission-specific chronic disease scores as alternative predictors of surgical site infection for patients undergoing coronary artery bypass graft surgery.
Admission-specific chronic disease scores as alternative predictors of surgical site infection for patients undergoing coronary artery bypass graft surgery.
复制标题
入院特异性慢性病评分作为接受冠状动脉搭桥手术患者手术部位感染的替代预测因素。
DOI：
10.1086/506394
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
Yokoe,DeborahS
中科院分区：
文献类型：
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作者：
Batista,Ruth;Kaye,Keith;Yokoe,DeborahS
目的评价入院慢性病评分（ACDS）及其变异作为冠状动脉旁路移植术（CABG）受试者手术部位感染（SSI）的预测因子。设计回顾性病例对照研究。设置一个750张床位的学术医疗中心。所有参与者均通过医院监测确定SSI（定义为病例患者）和CABG手术后无SSI的参与者随机样本（定义为对照受试者）在1999年7月1日至6月30日期间，结果264例研究参与者在手术前一天入院，根据入院当天的药物医嘱确定ACDS。根据281名参与者的门诊用药情况计算入院前慢性病评分（PACDS），使用患者出院总结中的入院前用药记录。病例组的ACDS和PACDS显著高于对照组（分别为P = 0.03和P = 0.05）。美国麻醉医师协会（阿萨）评分和标准的国家医院感染监测系统（NNIS）风险指数不是SSI的显著预测因子。在logistic回归模型中，只有ACDS（优势比，1.02/100 ACDS点），PACDS（比值比，每100个PACDS点1.02），PACDS五分位数中最高的（比值比，2.89 [与最低五分位数相比]），改良NNIS-PACDS评分为2（比值比，3.5 [与0分相比]）是SSI的显著预测因子。结论由于术前用药可能反映影响SSI风险的合并症，与标准NNIS风险指数相比，基于药物的评分系统（如ACDS和PACDS）可以实现更好的风险分层，特别是对于伤口分类和阿萨评分分布相对均匀的患者人群。
ObjectiveTo evaluate the admission chronic disease score (ACDS) and a variant of the ACDS as predictors of surgical site infection (SSI) for study participants who underwent coronary artery bypass graft (CABG) surgery.DesignRetrospective case-control study.SettingA 750-bed academic medical center.ParticipantsAll participants with an SSI that was identified through hospital-based surveillance (defined as case patients) and a random sample of participants without SSI following CABG surgery (defined as control subjects) between July 1, 1999, and June 30, 2001.ResultsAn ACDS based on medications ordered on the day of hospital admission was determined for 264 study participants admitted prior to the day of the surgical procedure. A preadmission chronic disease score (PACDS) based on outpatient medications was calculated for 281 participants, using the record of preadmission medications in the patient's discharge summary. The ACDS and PACDS were significantly higher for case patients, compared with control subjects (P = .03 and P = .05, respectively). American Society of Anesthesiologists (ASA) score and the standard National Nosocomial Infection Surveillance system (NNIS) risk index were not significant predictors of SSI. In logistic regression models, only the ACDS (odds ratio, 1.02 per 100 ACDS points), the PACDS (odds ratio, 1.02 per 100 PACDS points), the highest PACDS quintile (odds ratio, 2.89 [compared with lowest quintile]), and a modified NNIS-PACDS score of 2 (odds ratio, 3.5 [compared with a score of 0]) were significant predictors of SSI.ConclusionsBecause preoperative medications are likely to reflect comorbidities that influence the risk of SSI, medication-based scoring systems such as the ACDS and PACDS may allow for better risk stratification than the standard NNIS risk index, particularly for patient populations with relatively homogenous wound classification and ASA score distributions.