Secondary Surgical Site Infection after Coronary Artery Bypass Grafting: A Multi-Institutional Prospective Cohort Study

Autor: Brian C. Gulack, Katherine A. Kirkwood, Wei Shi, Peter K. Smith, John H. Alexander, Sandra G. Burks, Annetine C. Gelijns, Vinod H. Thourani, Daniel Bell, Ann Greenberg, Seth D. Goldfarb, Mary Lou Mayer, Michael E. Bowdish, Marissa A. Miller, Wendy C. Taddei-Peters, Dennis Buxton, Ron Caulder, Nancy L. Geller, David Gordon, Neal O. Jeffries, Albert Lee, Claudia S. Moy, Ilana Kogan Gombos, Jennifer Ralph, Timothy J. Gardner, Patrick T. O'Gara, Michael K. Parides, Deborah D. Ascheim, Alan J. Moskowitz, Ellen Moquete, Eric A. Rose, Melissa Chase, Yingchun Chen, Rosemarie Gagliardi, Lopa Gupta, Edlira Kumbarce, Ron Levitan, Karen O'Sullivan, Milerva Santos, Alan Weinberg, Paula Williams, Carrie Wood, Xia Ye, Eugene H. Blackstone, A. Marc Gillinov, Pamela Lackner, Leoma Berroteran, Diana Dolney, Suzanne Fleming, Roberta Palumbo, Christine Whitman, Kathy Sankovic, Denise Kosty Sweeney, Gregory Pattakos, Pamela A. Clarke, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R. Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Danielle Van Patten, Stacey Welsh, Carmelo A. Milano, Donald D. Glower, Joseph P. Mathew, J. Kevin Harrison, Mark F. Berry, Cyrus J. Parsa, Betty C. Tong, Judson B. Williams, T. Bruce Ferguson, Alan P. Kypson, Evelio Rodriguez, Malissa Harris, Brenda Akers, Allison O'Neal, John D. Puskas, Robert Guyton, Jefferson Baer, Kim Baio, Alexis A. Neill, Robert E. Michler, David A. D'Alessandro, Joseph J. DeRose, Daniel J. Goldstein, Ricardo Bello, William Jakobleff, Mario Garcia, Cynthia Taub, Daniel Spevak, Roger Swayze, Louis P. Perrault, Arsène-Joseph Basmadjian, Denis Bouchard, Michel Carrier, Raymond Cartier, Michel Pellerin, Jean François Tanguay, Ismael El-Hamamsy, André Denault, Jonathan Lacharité, Sophie Robichaud, Keith A. Horvath, Philip C. Corcoran, Michael P. Siegenthaler, Mandy Murphy, Margaret Iraola, Michael A. Acker, Y. Joseph Woo, Irving L. Kron, Gorav Ailawadi, Karen Johnston, John M. Dent, John Kern, Jessica Keim Sandra Burks, Kim Gahring, David A. Bull, Patrice Desvigne-Nickens, Dennis O. Dixon, Mark Haigney, Richard Holubkov, Alice Jacobs, Frank Miller, John M. Murkin, John Spertus, Andrew S. Wechsler, Frank Sellke, Cheryl L. McDonald, Robert Byington, Neal Dickert, John S. Ikonomidis, David O. Williams, Clyde W. Yancy, James C. Fang, Wayne Richenbacher, Vivek Rao, Karen L. Furie, Rachel Miller, Sean Pinney, William C. Roberts, Shirish Huprikar, Marilyn Levi
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
030204 cardiovascular system & hematology
Patient Readmission
Risk Assessment
Article
Body Mass Index
03 medical and health sciences
0302 clinical medicine
Risk Factors
Interquartile range
medicine
Humans
Surgical Wound Infection
Saphenous Vein
Prospective Studies
030212 general & internal medicine
Coronary Artery Bypass
Prospective cohort study
Aged
Groin
business.industry
Incidence
Hazard ratio
Length of Stay
Middle Aged
United States
Confidence interval
Anti-Bacterial Agents
Surgery
Treatment Outcome
Editorial
surgical procedures
operative
medicine.anatomical_structure
Tissue and Organ Harvesting
Female
Erythrocyte Transfusion
Cardiology and Cardiovascular Medicine
business
Complication
Body mass index
Artery
Popis: OBJECTIVE: To analyze patient risk factors and processes of care associated with secondary surgical site infection (SSI) after coronary artery bypass grafting (CABG). METHODS: Data were collected prospectively between February and October 2010 for consenting adult patients undergoing CABG with saphenous vein graft (SVG) conduits. Patients who developed a deep or superficial SSI of the leg or groin within 65 days of CABG were compared to those who did not develop a secondary SSI. RESULTS: Among 2,174 patients identified, 65 (3.0%) developed a secondary SSI. Median time to diagnosis was 16 days (interquartile range [IQR]: 11 - 29) with the majority (86%) diagnosed after discharge. Gram-positive bacteria were most common. Readmission was more common in patients with a secondary SSI (34% vs 17%, p < 0.01). After adjustment, an open SVG harvest approach was associated with an increased risk of secondary SSI (adjusted hazard ratio [HR]: 2.12, 95% confidence interval [CI]: 1.28, 3.48). Increased body mass index (BMI) (adjusted HR: 1.08, 95% CI: 1.04, 1.12) and packed red blood cell (PRBC) transfusions (adjusted HR: 1.13, 95% CI: 1.05, 1.22) were associated with a higher risk of secondary SSI. Antibiotic type, antibiotic duration, and post-operative hyperglycemia were not associated with risk of secondary SSI. CONCLUSIONS: Secondary SSI following CABG continues to be an important source of morbidity. This serious complication often occurs after discharge and is associated with open SVG harvesting, larger BMI, and blood transfusions. Patients with a secondary SSI have longer lengths of stay and are readmitted more frequently.
Databáze: OpenAIRE
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