Author/Authors :
Gelijns، نويسنده , , Annetine C. and Moskowitz، نويسنده , , Alan J. and Acker، نويسنده , , Michael A. and Argenziano، نويسنده , , Michael and Geller، نويسنده , , Nancy L. and Puskas، نويسنده , , John D. and Perrault، نويسنده , , Louis P. and Smith، نويسنده , , Peter K. and Kron، نويسنده , , Irving L. and Michler، نويسنده , , Robert E. and Miller، نويسنده , , Marissa A. and Gardner، نويسنده , , Timothy J. and Ascheim، نويسنده , , Deborah D. and Ailawadi، نويسنده , , Gorav and Lackner، نويسنده , , Pamela and Goldsmith، نويسنده , , Lyn A. and Robichaud، نويسنده , , Sophie and Miller، نويسنده , , Rachel A. and Rose، نويسنده , , Eric A. and Ferguson Jr.، نويسنده , , T. Bruce and Horvath، نويسنده , , Keith A. and Moquete، نويسنده , , Ellen G. and Parides، نويسنده , , Michael K. and Bagiella، نويسنده , , Emilia and OʹGara، نويسنده , , Patrick T. and Blackstone، نويسنده , , Eugene H.، نويسنده ,
Abstract :
AbstractBackground
ions are the most common noncardiac complication after cardiac surgery, but their incidence across a broad range of operations, as well as the management factors that shape infection risk, remain unknown.
ives
tudy sought to prospectively examine the frequency of post-operative infections and associated mortality, and modifiable management practices predictive of infections within 65 days from cardiac surgery.
s
tudy enrolled 5,158 patients and analyzed independently adjudicated infections using a competing risk model (with death as the competing event).
s
5% of patients experienced major infections. Baseline characteristics associated with increased infection risk included chronic lung disease (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.21 to 2.26), heart failure (HR: 1.47; 95% CI: 1.11 to 1.95), and longer surgery (HR: 1.31; 95% CI: 1.21 to 1.41). Practices associated with reduced infection risk included prophylaxis with second-generation cephalosporins (HR: 0.70; 95% CI: 0.52 to 0.94), whereas post-operative antibiotic duration >48 h (HR: 1.92; 95% CI: 1.28 to 2.88), stress hyperglycemia (HR: 1.32; 95% CI: 1.01 to 1.73); intubation time of 24 to 48 h (HR: 1.49; 95% CI: 1.04 to 2.14); and ventilation >48 h (HR: 2.45; 95% CI: 1.66 to 3.63) were associated with increased risk. HRs for infection were similar with either <24 h or <48 h of antibiotic prophylaxis. There was a significant but differential effect of transfusion by surgery type (excluding left ventricular assist device procedures/transplant) (HR: 1.13; 95% CI: 1.07 to 1.20). Major infections substantially increased mortality (HR: 10.02; 95% CI: 6.12 to 16.39).
sions
infections dramatically affect survival and readmissions. Second-generation cephalosporins were strongly associated with reduced major infection risk, but optimal duration of antibiotic prophylaxis requires further study. Given practice variations, considerable opportunities exist for improving outcomes and preventing readmissions. (Management Practices and Risk of Infection Following Cardiac Surgery; NCT01089712)
