Are there independent predisposing factors for postoperative infections following open heart surgery?

<p>Abstract</p> <p>Background</p> <p>Nosocomial infections after cardiac surgery represent serious complications associated with substantial morbidity, mortality and economic burden. This study was undertaken to evaluate the frequency, characteristics, and risk factors of microbiologically documented nosocomial infections after cardiac surgery in a Cardio-Vascular Intensive Care Unit (CVICU).</p> <p>Methods</p> <p>All patients who underwent open heart surgery between May 2006 and March 2008 were enrolled in this prospective study. Pre-, intra- and postoperative variables were collected and examined as possible risk factors for development of nosocomial infections. The diagnosis of infection was always microbiologically confirmed.</p> <p>Results</p> <p>Infection occurred in 24 of 172 patients (13.95%). Out of 172 patients, 8 patients (4.65%) had superficial wound infection at the sternotomy site, 5 patients (2.9%) had central venous catheter infection, 4 patients (2.32%) had pneumonia, 9 patients (5.23%) had bacteremia, one patient (0.58%) had mediastinitis, one (0.58%) had harvest surgical site infection, one (0.58%) had urinary tract infection, and another one patient (0.58%) had other major infection. The mortality rate was 25% among the patients with infection and 3.48% among all patients who underwent cardiac surgery compared with 5.4% of patients who did not develop early postoperative infection after cardiac surgery. Culture results demonstrated equal frequencies of gram-positive cocci and gram-negative bacteria. A backward stepwise multivariable logistic regression model analysis identified diabetes mellitus (OR 5.92, CI 1.56 to 22.42, p = 0.009), duration of mechanical ventilation (OR 1.30, CI 1.005 to 1.69, p = 0.046), development of severe complications in the CICU (OR 18.66, CI 3.36 to 103.61, p = 0.001) and re-admission to the CVICU (OR 8.59, CI 2.02 to 36.45, p = 0.004) as independent risk factors associated with development of nosocomial infection after cardiac surgery.</p> <p>Conclusions</p> <p>We concluded that diabetes mellitus, the duration of mechanical ventilation, the presence of complications irrelevant to the infection during CVICU stay and CVICU re-admission are independent risk factors for the development of postoperative infection in cardiac surgery patients.</p

Infections in cardiac surgery patients: are there independent predisposing factors for postoperative infections following open heart surgery?

Background: Nosocomial infections after cardiac surgery represent serious complications associated with substantial morbidity, mortality and economic burden. This study was undertaken to evaluate the frequency, characteristics, and risk factors of microbiologically documented nosocomial infections after cardiac surgery in a Cardio-Vascular Intensive Care Unit (CVICU). Methods: All patients who underwent open heart surgery between May 2006 and March 2008 were enrolled in this prospective study. Pre-, intra- and postoperative variables were collected and examined as possible risk factors for development of nosocomial infections. The diagnosis of infection was always microbiologically confirmed. Results: Infection occurred in 24 of 172 patients (13.95%). Out of 172 patients, 8 patients (4.65%) had superficial wound infection at the sternotomy site, 5 patients (2.9%) had central venous catheter infection, 4 patients (2.32%) had pneumonia, 9 patients (5.23%) had bacteremia, one patient (0.58%) had mediastinitis, one (0.58%) had harvest surgical site infection, one (0.58%) had urinary tract infection, and another one patient (0.58%) had other major infection. The mortality rate was 25% among the patients with infection and 3.48% among all patients who underwent cardiac surgery compared with 5.4% of patients who did not develop early postoperative infection after cardiac surgery. Culture results demonstrated equal frequencies of gram-positive cocci and gram-negative bacteria. A backward stepwise multivariable logistic regression model analysis identified diabetes mellitus (OR 5.92, CI 1.56 to 22.42, p=0.009), duration of mechanical ventilation (OR 1.30, CI 1.005 to 1.69, p=0.046), development of severe complications in the CICU (OR 18.66, CI 3.36 to 103.61, p=0.001) and re-admission to the CVICU (OR 8.59, CI 2.02 to 36.45, p=0.004) as independent risk factors associated with development of nosocomial infection after cardiac surgery. Conclusions: We concluded that diabetes mellitus, the duration of mechanical ventilation, the presence of complications irrelevant to the infection during CVICU stay and CVICU re-admission are independent risk factors for the development of postoperative infection in cardiac surgery patients.Σκοπός: Να μελετηθούν η συχνότητα, τα χαρακτηριστικά και οι παράγοντες κινδύνου των λοιμώξεων στην Καρδιοχειρουργική Μονάδα, σε ασθενείς που υποβλήθηκαν σε καρδιοχειρουργική επέμβαση με και χωρίς εξωσωματική κυκλοφορία. Υλικό και Μέθοδοι: Μέσα σε μία περίοδο 22 μηνών μελετήθηκαν διαδοχικά όλοι οι ενήλικες ασθενείς, οι οποίοι υποβλήθηκαν σε καρδιοχειρουργική επέμβαση. Καταγράφηκαν προεγχειρητικά, διεγχειρητικά και μετεγχειρητικά στοιχεία και διερευνήθηκε η συσχέτισή τους με την ανάπτυξη των ενδονοσοκομειακών λοιμώξεων. Η στατιστική ανάλυση των αποτελεσμάτων έγινε με το SPSS 15.0. Αποτελέσματα: Aπό τους 172 ασθενείς, 24 (13,95%) ανέπτυξαν ενδονοσοκομειακή λοίμωξη, 8 (4,65%) είχαν επιφανειακή λοίμωξη στη στερνοτομή, 5 (2,9%) ανέπτυξαν λοίμωξη από κεντρικό καθετήρα, 4 (2,32%) είχαν πνευμονία, 9 (5,23%) βακτηριαιμία, 1 (0,58%) μεσοθωρακίτιδα, 1 (0,58%) λοίμωξη χειρουργικού τραύματος, 1 (0,58%) ουρολοίμωξη και 1 (0,58%) λοίμωξη λόγω ενδοαορτικού ασκού. Η θνητότητα ήταν 25% μεταξύ των ασθενών με λοίμωξη, ενώ η συνολική 3.48%. Τα αποτελέσματα από τις καλλιέργειες έδειξαν ίση συχνότητα σε Gram-θετικούς κόκκους και Gram-αρνητικά βακτήρια. Παράγοντες κινδύνου απετέλεσαν ο σακχαρώδης διαβήτης (OR 5.92, CI 1.56 to 22.42, p=0.009), η μεγάλη διάρκεια του μηχανικού αερισμού (OR 1.30, CI 1.005 to 1.69, p=0.046), οι σοβαρές επιπλοκές στη Μονάδα (OR 18.66, CI 3.36 to 103.61, p=0.001), όπως επίσης και η επανείσοδος στη Μονάδα (OR 8.59, CI 2.02 to 36.45, p=0.004). Συμπεράσματα: Ο σακχαρώδης διαβήτης, η παράταση του μηχανικού αερισμού, οι σοβαρές επιπλοκές και η επαναεισαγωγή στη Μονάδα απετέλεσαν προδιαθεσικούς παράγοντες ανάπτυξης λοίμωξης

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London