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Risk Features for Surgical-Site Infections in Coronary Artery Bypass Surgery

Published online by Cambridge University Press:  02 January 2015

Sailaritta Vuorisalo*
Affiliation:
Department of Surgery, University of Oulu
Kari Haukipuro
Affiliation:
Department of Surgery, University of Oulu
Risto Pokela
Affiliation:
Department of Surgery, University of Oulu
Hannu Syrjälä
Affiliation:
Department of Infection Control, Oulu University Hospital, Oulu, Finland
*
Department of Surgery, Central Hospital of Pori, Sairaalantie 3, FIN-28500 Pori, Finland

Abstract

OBJECTIVE: To identify preoperative and perioperative features that may lead to a risk of surgical-site infection (SSI) after coronary artery bypass surgery.

DESIGN: 884 patients who underwent coronary artery bypass grafting in 1992 and 1993 were studied. The associations between 23 preoperative and perioperative features and the presence of SSI at the donor site or in the chest area were evaluated by univariate analysis followed by multivariate logistic regression analysis.

SETTING: A university hospital.

RESULTS: 172 patients (19.5%) either had an SSI recorded before discharge or had received antibiotics prescribed for a suspected SSI during the 1-month surveillance period after discharge. Multivariate logistic regression analysis showed an extreme body mass index (BMI; P=.015), female gender (P=.023), and chronic obstructive pulmonary disease (COPD; P=.030) to be independent risk features for SSI. The donor site was infected in 136 patients (15.4%), an event for which female gender (P=.003) was the only independent risk feature. Forty-seven patients (5.3%) had an SSI of the chest area, with diabetes (P=.003) and extreme BMI (P=.010) as independent risk features.

CONCLUSION: Extreme BMI, female gender, and COPD are highly significant independent predictors of the development of SSI. Female gender is a risk feature specifically for SSI at the donor site, whereas diabetes and extreme BMI predict it in the chest area.

Type
Research Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

REFERENCES

1. Horan, TC, Culver, DH, Gaynes, RP, Jarvis, WR, Edwards, JR, Reid, CR, et al. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. Infect Control Hosp Epidemiol 1993;14:7380.Google Scholar
2. Loop, FD, Lytle, BW, Cosgrove, DM, Mahfood, S, McHenry, MC, Gormastic, M, et al. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990;49:179187.Google Scholar
3. Nagachinta, T, Stephens, M, Reitz, B, Polk, F. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987;156:967973.Google Scholar
4. Ottino, G, De Paulis, R, Pansini, S, Rocca, G, Tallone, MV, Comoglio, C, et al. Major sternal wound infection after open- heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg 1987;44:173179.Google Scholar
5. Milano, CA, Kesler, K, Archibald, N, Sexton, DJJ, Jones, RH. Mediastinitis after coronary artery bypass graft surgery. Circulation 1995;92:22452251.Google Scholar
6. Newman, LS, Szczukowski, LC, Bain, RP, Perlino, CA. Suppurative mediastinitis after open heart surgery. Chest 1988;94:4653.Google Scholar
7. Demmy, TL, Park, SB, Liebler, GA, Burkholder, JA, Maher, TD, Benckart, DH, et al. Recent experience with major sternal wound complications. Ann Thorac Surg 1990;49:458462.Google Scholar
8. Slaughter, MS, Olson, MM, Lee, JT Jr, Ward, HB. A fifteen-year wound surveillance study after coronary artery bypass. Ann Thorac Surg 1993;56:10631068.Google Scholar
9. L'Ecuyer, PB, Murphy, D, Little, R, Fraser, VJ. The epidemiology of chest and leg wound infections following cardiothoracic surgery. Clin Infect Dis 1996;22:424429.Google Scholar
10. Vuorisalo, S, Pokela, R, Syrjälä, H. Comparison of vancomycin and cefuroxime for infection prophylaxis in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1998;19:234239.Google Scholar
11. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical-site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606608.Google Scholar
12. Brown, RB, Bradley, S, Opitz, E, Cipriani, D, Pieczarka, R, Sands, M. Surgical wound infections documented after hospital discharge. Am J Infect Control 1987;15:5458.Google Scholar
13. Conklin, CM, Gray, RJ, Neilson, D, Wong, P, Tomita, DK, Matloff, JM. Determinants of wound infection incidence after isolated coronary artery bypass surgery in patients randomized to receive prophylactic cefuroxime or cefazolin. Ann Thorac Surg 1988;46:172177.Google Scholar
14. Olson, MM, Lee, JT Jr. Continuous, 10-year wound infection surveillance. Arch Surg 1990;125:794803.Google Scholar
15. Nishida, H, Grooters, RK, Soltanzadeh, H, Thieman, KC, Schneider, RF, Kim, W-P. Discriminate use of electrocautery on the median sternotomy incision. J Thorac Cardiovasc Surg 1991;101:488494.Google ScholarPubMed
16. Holtz, TH, Wenzel, RP. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992;20:206213.Google Scholar
17. Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963970.Google Scholar
18. Perri, GP, Nezu, AM, Viegener, BJ. Improving the Long-Term Management of Obesity. New York, NY: John Wiley & Sons; 1992:6.Google Scholar
19. Forse, RA, Karam, B, MacLean, LD, Christou, NV. Antibiotic prophylaxis for surgery in morbidly obese patients. Surgery 1989;106:750757.Google ScholarPubMed
20. Cohen, A, Katz, M, Katz, R, Hauptman, E, Schachner, A. Chronic obstructive pulmonary disease in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 1995;109:574581.Google Scholar
21. Babineau, TJ, Bothe, A Jr. General surgery considerations in the diabetic patient. Infect Dis Clin North Am 1995;9:183193.Google Scholar
22. McMahon, MM, Bistrian, BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 1995;9:19.Google ScholarPubMed
23. Ennker, J, Rehm, I, Horst, P, Hausmann, H, Schirop, R. Importance of adequate preoperative management of diabetes mellitus: effect on incidence of infection after coronary revas-cularization. 43rd International Congress of the European Society for Cardiovascular Surgery. Berlin, Germany; 09 6-9, 1994. Abstract.Google Scholar
24. Alexiewicz, JM, Kumar, D, Smogorzewski, M, Klin, M, Massry, SG. Polymorphonuclear leukocytes in non-insulin-dependent diabetes mellitus: abnormalities in metabolism and function. Ann Intern Med 1995;123:919924.Google Scholar
25. Rebollo, MH, Bernal, JM, Llorca, J, Rabasa, JM, Revuelta, JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996;112:908913.Google Scholar
26. Cosgrove, DM, Lytle, BW, Loop, FD,Taylor, PC, Stewart, RW, Gill, CC, et al. Does bilateral internal mammary artery grafting increase surgical risk? J Thorac Cardiovasc Surg 1988;95:850856.Google Scholar
27. Kouchoukos, NT, Wareing, TH, Murphy, SF, Pelate, C, Marshall, WG Jr. Risks of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 1990;49:210219.Google Scholar
28. Dineen, P. The effect of suture material on the development of vascular infections. Vascular Surgery 1977;11:2933.Google Scholar
29. Katz, SV, Izhar, M, Mirelman, D. Bacterial adherence to surgical sutures: a possible factor in suture-induced infection. Ann Surg 1981;194:3541.Google ScholarPubMed