Brian C Gulack1, Katherine A Kirkwood2, Wei Shi2, Peter K Smith1, John H Alexander3, Sandra G Burks4, Annetine C Gelijns5, Vinod H Thourani6, Daniel Bell7, Ann Greenberg8, Seth D Goldfarb2, Mary Lou Mayer9, Michael E Bowdish10. 1. Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Health, Durham, NC. 2. International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY. 3. Division of Cardiology, Duke Clinical Research Institute, Duke Health, Durham, NC. 4. Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va. 5. International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY. Electronic address: annetine.gelijns@mssm.edu. 6. Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC. 7. Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY. 8. Department of Cardiothoracic Surgery, NIH Heart Center at Suburban Hospital, Bethesda, Md. 9. Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. 10. Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
Abstract
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 with those who did not develop a secondary SSI. RESULTS: Among 2174 patients identified, 65 (3.0%) developed a secondary SSI. Median time to diagnosis was 16 days (interquartile range 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 < .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 (adjusted HR, 1.08, 95% CI, 1.04-1.12) and packed red blood cell transfusions (adjusted HR, 1.13; 95% CI, 1.05-1.22) were associated with a greater risk of secondary SSI. Antibiotic type, antibiotic duration, and postoperative hyperglycemia were not associated with risk of secondary SSI. CONCLUSIONS: Secondary SSI after CABG continues to be an important source of morbidity. This serious complication often occurs after discharge and is associated with open SVG harvesting, larger body mass, and blood transfusions. Patients with a secondary SSI have longer lengths of stay and are readmitted more frequently.
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 with those who did not develop a secondary SSI. RESULTS: Among 2174 patients identified, 65 (3.0%) developed a secondary SSI. Median time to diagnosis was 16 days (interquartile range 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 < .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 (adjusted HR, 1.08, 95% CI, 1.04-1.12) and packed red blood cell transfusions (adjusted HR, 1.13; 95% CI, 1.05-1.22) were associated with a greater risk of secondary SSI. Antibiotic type, antibiotic duration, and postoperative hyperglycemia were not associated with risk of secondary SSI. CONCLUSIONS: Secondary SSI after CABG continues to be an important source of morbidity. This serious complication often occurs after discharge and is associated with open SVG harvesting, larger body mass, and blood transfusions. Patients with a secondary SSI have longer lengths of stay and are readmitted more frequently.
Keywords:
body mass index; coronary artery bypass grafting; postoperative length of stay; postoperative readmission; red blood cell transfusion; saphenous vein graft; surgical site infection
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