Predictors of surgical site infection following adult cardiac surgery at the Jewish General Hospital: a cohort study
Bibliographic record
Abstract
Background Surgical site infections (SSI) are the second most common cause of nosocomial infections and thus constitute a major concern to hospitals. SSIs of the sternal and graft site wounds following cardiac surgery are associated with increases in hospitalisation costs, length of in-hospital stays, and mortality. ObjectiveTo identify modifiable risk factors for the development of SSIs within up to one year of surgery following invasive cardiac surgery at the Jewish General Hospital in Montreal (JGH), Quebec. SSIs of interest include both sternal wound infections (SWIs) and leg incision infections (LIIs). Methods Using the Quebec Registry in Adult Cardiac Surgery (QRACS), the cohort of all patients undergoing cardiac surgery at the JGH between 1 April 2011 and 31 October 2013 was identified. Outcomes of interest included all surgical site infections identified in the QRACS during a maximum of one year of follow-up, with particular attention paid to SWIs and LIIs. Survival analysis using the Cox proportional hazards model was used to estimate the hazard ratios (HRs) of SSI associated with pre- and intraoperative risk factors. The Kaplan-Meier method for survival data was employed to estimate cumulative incidence of sternal and leg SSIs. ResultsThe cohort included 1,210 patients who were on average 67 years old at the time of surgery and 72.1% were male. SWIs constituted 77.9% of all SSI and LIIs 22.1%. In multivariate analysis, failing to remove hair from surgical sites prior to surgery (HR: 2.30, 95% CI: 1.18-4.48), surgeon B (HR: 1.87, 95% CI: 1.08-3.23), and use of immunosuppressants/steroids (HR: 3.20, 95% CI: 1.36-7.54) were significantly associated with all varieties of infection. In addition, use of α-blockers (HR: 3.62, 95% CI: 1.39-9.48) and immunosuppressants/steroids (HR: 9.40, 95% CI: 2.65-33.42) were associated specifically with SWI and LII, respectively.ConclusionPatients with the identified modifiable risk factors should be monitored closely. The usefulness of the QRACS in monitoring SSIs was demonstrated.KeywordsSurgical site infections (SSI), Cardiac surgery, Sternal wound infections (SWI), Quebec Registry in Adult Cardiac Surgery (QRACS)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".