HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sean M. O'Brien Karl F. Welke Marshall L. Jacobs Jeffrey P. Jacobs Eric D. Peterson James Jaggers Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barker, G. M. Articles by Li, J. S. Search for Related Content PubMed PubMed Citation Articles by Barker, G. M. Articles by Li, J. S. Related Collections Congenital - acyanotic Congenital - cyanotic

---

Original Articles: Pediatric Cardiac

Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

^a Duke University Medical Center, Durham, North Carolina
^b Oregon Health and Science University, Portland, Oregon
^c Cleveland Clinic, Cleveland, Ohio
^d The Congenital Heart Institute of Florida, Saint Petersburg and Tampa, Florida

Accepted for publication November 19, 2009.

^_* Address correspondence to Dr Li, DUMC Box 3090, Durham, NC 27710 (Email: jennifer.li{at}duke.edu).

Background: In pediatric cardiac surgery, infection is a leading cause of morbidity and mortality. We created a model to predict risk of major infection in this population.

Methods: Using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we created a multivariable model in which the primary outcome was major infection (septicemia, mediastinitis, or endocarditis). Candidate-independent variables included demographic characteristics, comorbid conditions, preoperative factors, and cardiac surgical procedures. We created a reduced model by backward selection and then created an integer scoring system using a scaling factor with scores corresponding to percent risk of infection.

Results: Of 30,078 children from 48 centers, 2.8% had major infection (2.6% septicemia, 0.3% mediastinitis, and 0.09% endocarditis). Mortality and postoperative length of stay were greater in those with major infection (mortality, 22.2% versus 3.0%; length of stay >21 days, 69.9% versus 10.7%). Young age, high complexity, previous cardiothoracic operation, preoperative length of stay more than 1 day, preoperative ventilator support, and presence of a genetic abnormality were associated with major infection after backward selection (p < 0.001). Estimated infection risk ranged from less than 0.1% to 13.3%; the model discrimination was good (c index, 0.79).

Conclusions: We created a simple bedside tool to identify children at high risk for major infection after cardiac surgery. These patients may be targeted for interventions to reduce the risk of infection and for inclusion in future clinical trials.

This article has been cited by other articles:

				A. Kansy, J. P. Jacobs, A. Pastuszko, M. Mirkowicz-Malek, M. Manowska, E. Jezierska, P. Maruszewski, P. Burczynski, and B. Maruszewski Major Infection After Pediatric Cardiac Surgery: External Validation of Risk Estimation Model Ann. Thorac. Surg., December 1, 2012; 94(6): 2091 - 2095. [Abstract] [Full Text] [PDF]

				C. S. Woodward, M. Son, R. Taylor, and S. A. Husain Prevention of Sternal Wound Infection in Pediatric Cardiac Surgery: A Protocolized Approach World Journal for Pediatric and Congenital Heart Surgery, October 1, 2012; 3(4): 463 - 469. [Abstract] [Full Text] [PDF]

				P. Guenter, L. Robinson, R. A. DiMaria-Ghalili, B. Lyman, E. Steiger, and M. F. Winkler Development of Sustain™: A.S.P.E.N.'s National Patient Registry for Nutrition Care JPEN J Parenter Enteral Nutr, July 1, 2012; 36(4): 399 - 406. [Abstract] [Full Text] [PDF]

				D. S. Wheeler, H. E. Jeffries, J. J. Zimmerman, H. R. Wong, and J. A. Carcillo Sepsis in the Pediatric Cardiac Intensive Care Unit World Journal for Pediatric and Congenital Heart Surgery, July 1, 2011; 2(3): 393 - 399. [Abstract] [Full Text] [PDF]

				I. Pagowska-Klimek, M. Pychynska-Pokorska, W. Krajewski, and J. J. Moll Predictors of long intensive care unit stay following cardiac surgery in children Eur J Cardiothorac Surg, July 1, 2011; 40(1): 179 - 184. [Abstract] [Full Text] [PDF]

				S. K. Pasquali, M. Hall, J. S. Li, E. D. Peterson, J. Jaggers, A. J. Lodge, B. S. Marino, D. M. Goodman, and S. S. Shah Corticosteroids and Outcome in Children Undergoing Congenital Heart Surgery: Analysis of the Pediatric Health Information Systems Database Circulation, November 23, 2010; 122(21): 2123 - 2130. [Abstract] [Full Text] [PDF]

				J. M. Giroud, J. P. Jacobs, D. Spicer, C. Backer, G. R. Martin, R. C. G. Franklin, M. J. Beland, O. N. Krogmann, V. D. Aiello, S. D. Colan, et al. Report From The International Society for Nomenclature of Paediatric and Congenital Heart Disease: Creation of a Visual Encyclopedia Illustrating the Terms and Definitions of the International Pediatric and Congenital Cardiac Code World Journal for Pediatric and Congenital Heart Surgery, October 1, 2010; 1(3): 300 - 313. [Abstract] [Full Text] [PDF]