Identifying potential predictors of the risk of surgical site infection following cardiac surgery: a scoping review

Abstract

Objectives: This scoping review was undertaken to identify risk prediction models and pre-operative predictors of surgical site infection (SSI) in adult cardiac surgery. A particular focus was on the identification of novel predictors that could underpin the future development of a risk prediction model to identify individuals at high risk of SSI, and therefore guide a national SSI prevention strategy.

Methods: A scoping review to systematically identify and map out existing research evidence on pre-operative predictors of SSI was conducted in two stages. Stage 1 reviewed prediction modelling studies of SSI in cardiac surgery. Stage 2 identified primary studies and systematic reviews of novel cardiac SSI predictors.

Results: The search identified 7887 unique reports; 7154 were excluded at abstract screening and 733 were selected for full-text assessment. Twenty-nine studies (across 30 reports) were included in Stage 1 and reported the development (N=14), validation (N=13), or both development and validation (N=2) of 52 SSI risk prediction models including 67 different pre-operative predictors. The remaining 703 reports were re-assessed in Stage 2; 49 studies met the inclusion criteria, and 56 novel pre-operative predictors that have not been assessed previously in models were identified.

Conclusions: This review identified 123 pre-operative predictors of the risk of SSI following cardiac surgery, 56 of which have not been included previously in the development of cardiac SSI risk prediction models. These candidate predictors will be a valuable resource in the future development of risk prediction scores, and may be relevant to prediction of the risk of SSI in other surgical specialities.

Keywords: Cardiac surgery; Risk prediction; Scoping review; Surgical site infection.