Hussey et al reported the Sternal Wound Prediction Scale-Revised (SWIPS-R) for identifying a patient at risk for sternal infection following open heart surgery. The authors are from the University of North Carolina in Charlotte.
Patient selection: open heart surgery
Differences from SWIPS:
(1) addition of smoking
(2) removal of pharmacologic support
(3) changes in point assignment
Parameters:
(1) smoking
(2) diabetes mellitus
(3) COPD
(4) preoperative stay in the ICU
(5) obesity (BMI > 30 kg per sq meter)
(6) age in years
(7) sex
(8) impaired immune response
(9) number of internal mammary arteries harvested
(10) operation time in hours
(11) re-exploration for bleeding
(12) cardiopulmonary bypass time in hours
(13) hypotension/hypoperfusion after surgery
(14) number of hours on ventilatory support after surgery
(15) postoperative CPR
(16) postoperative hypoxemia
(17) transfusion of banked blood
(18) vasopressor use
Preoperative items: 1 to 8
Intraoperative items: 9 to 12
Postoperative items: 13 to 18
|
Parameter |
Finding |
Points |
|
smoking |
no |
0 |
|
|
yes |
9 |
|
diabetes |
no |
0 |
|
|
non-insulin dependent |
5 |
|
|
insulin dependent |
7 |
|
COPD |
no |
0 |
|
|
yes |
8 |
|
preop stay in ICU |
no |
0 |
|
|
yes |
4 |
|
obesity |
no |
0 |
|
|
yes |
4 |
|
age in years |
<= 70 years |
0 |
|
|
> 70 years |
3 |
|
sex |
female |
0 |
|
|
male |
1 |
|
impaired immune response |
no |
0 |
|
|
yes |
8 |
|
number of IMA harvested |
none |
0 |
|
|
1 |
3 |
|
|
2 |
6 |
|
operation time |
<= 4 hours |
0 |
|
|
> 4 hours |
7 |
|
re-exploration |
no |
0 |
|
|
yes |
6 |
|
cardiopulmonary bypass |
<= 2 hours |
0 |
|
|
> 2 hours |
6 |
|
hypotension/hypoperfusion |
no |
0 |
|
|
yes |
8 |
|
ventilatory support |
<= 48 hours |
0 |
|
|
> 48 hours |
6 |
|
postoperative CPR |
no |
0 |
|
|
yes |
7 |
|
postoperative hypoxemia |
no |
0 |
|
|
yes |
5 |
|
transfusion |
no |
0 |
|
|
yes |
3 |
|
vasopressors |
none |
0 |
|
|
dopamine or dobutamine alone |
2 |
|
|
all others |
6 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 104
• A score >= 28 is associated with sternal infection
Specialty: Infectious Diseases
