Benedetto et al developed a nomogram for evaluating a patient undergoing median sternotomy. This can help to identify a patient who may benefit from more aggressive management to avoid a deep sternal infection, such as placement of a gentamicin-impregnated collagen sponge (GICS). The authors are from Harefield Hospital in London.
Patient selection: median sternotomy, BMI from10 to 55 kilograms per square meter
Parameters:
(1) gender
(2) body mass index (BMI) in kilograms per square meter
(3) diabetes treated with insulin
(4) isolated or combined coronary artery bypass graft (CABG)
(5) surgery as re-exploration procedure
(6) bilateral internal mammary artery grafts (if CABG performed)
points for body mass index =
= (2.222 * (BMI)) - 22.22
|
Parameter |
Finding |
Points |
|
gender |
male |
0 |
|
|
female |
26.3 |
|
diabetes on insulin |
no |
0 |
|
|
yes |
20 |
|
CABG |
no |
0 |
|
|
yes |
19 |
|
re-exploration |
no |
0 |
|
|
yes |
51 |
|
bilateral internal mammary artery grafts |
no |
0 |
|
|
yes |
15 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: around 241
• The higher the score the greater the risk of a deep sternal infection.
|
Score |
Percent with Sternal Wound Infection |
|
0 to 31 |
< 0.1% |
|
31 to 116 |
< 1% |
|
116 to 136 |
1-2% |
|
136 to 226 |
(0.00408 * ((score)^2)) - (1.145 * (score)) + 82.66 |
|
Score |
Risk Group |
Management Suggestion |
|
< 136 |
low risk |
None |
|
136 to 199 |
moderate risk |
gentamicin impregnated collagen sponge (GICS) |
|
> 199 |
high risk |
GICS plus additional measures |
Specialty: Infectious Diseases
