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Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study

2017; Elsevier BV; Volume: 155; Issue: 4 Linguagem: Inglês

10.1016/j.jtcvs.2017.10.078

1097-685X

Brian C. Gulack, Katherine Kirkwood, Wei Shi, Peter K. Smith, John H. Alexander, Sandra G. Burks, Annetine C. Gelijns, Vinod H. Thourani, Daniel Bell, Ann Greenberg, Seth Goldfarb, Mary Lou Mayer, Michael E. Bowdish, Marissa A. Miller, Wendy C. Taddei‐Peters, Dennis Buxton, Ron Caulder, Nancy L. Geller, David F. Gordon, Neal Jeffries, Albert Lee, Claudia S. Moy, Ilana Kogan Gombos, Jennifer Ralph, Timothy J. Gardner, Patrick T. O’Gara, Annetine C. Gelijns, 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 A. 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.G. Clarke, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R. Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Daniel Bell, Danielle Van Patten, Peter K. Smith, Stacey Welsh, John H. Alexander, 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 Rodríguez, Malissa Harris, Brenda Akers, Allison O'Neal, John D. Puskas, Vinod H. Thourani, Robert A. Guyton, Jefferson Baer, Kim T. Baio, Alexis A. Neill, Robert E. Michler, David A. D’Alessandro, Joseph J. DeRose, Daniel J. Goldstein, Ricardo Bello, William Jakobleff, Mario Garcia, Cynthia C. 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 J. Horvath, Philip C. Corcoran, Michael Siegenthaler, Mandy Murphy, Margaret Iraola, Ann Greenberg, Michael A. Acker, Young Woo, Mary Lou Mayer, Irving L. Kron, Gorav Ailawadi, Karen C. Johnston, John Dent, John A. Kern, Jessica Keim Sandra Burks, Kim Gahring, David A. Bull, Patrice Desvigne‐Nickens, Dennis O. Dixon, Mark C. Haigney, Richard Holubkov, Alice Jacobs, Frank E. Miller, John M. Murkin, John A. Spertus, Andrew S. Wechsler, Frank W. Sellke, Cheryl L. McDonald, Robert Byington, Neal W. Dickert, Dennis O. Dixon, John S. Ikonomidis, David O. Williams, Clyde W. Yancy, James C. Fang, Wayne Richenbacher, V. Rao, Karen L. Furie, Rachel Miller, Sean Pinney, William C. Roberts, Rachel Miller, Shirish Huprikar, Marilyn E. Levi,

Cardiac, Anesthesia and Surgical Outcomes

ObjectiveTo analyze patient risk factors and processes of care associated with secondary surgical-site infection (SSI) after coronary artery bypass grafting (CABG).MethodsData 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.ResultsAmong 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.ConclusionsSecondary 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.