Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Gorav Ailawadi, Helena L. Chang, Patrick T. O'Gara, Karen O'Sullivan, Y. Joseph Woo, Joseph DeRose, Michael K. Parides, Vinod H. Thourani, Sophie Robichaud, A. Marc Gillinov, Wendy C. Taddei-Peters, Marissa A. Miller, Louis P. Perrault, Robert L. Smith, Lyn Goldsmith, Keith A. Horvath, Kristen Doud, Kim Baio, Annetine C. Gelijns, Alan J. MoskowitzEmilia Bagiella, John H. Alexander, Alexander Iribarne

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Rationale: Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. Objectives: To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes. Methods: A total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model. Measurements and Main Results: The cumulative incidence of pneumonia was 2.4%, 33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95% CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95% CI, 10.31-16.58). Conclusions: Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jul 27 2016

Fingerprint

National Institutes of Health (U.S.)
Thoracic Surgery
Pneumonia
Confidence Intervals
Health
Practice Management
Length of Stay
Platelet Transfusion
Heart-Assist Devices
Mortality
Cephalosporins
Operative Time
Quality Improvement
Infection
Ambulatory Surgical Procedures
Proportional Hazards Models
Chronic Obstructive Pulmonary Disease
Ventilation
Blood Cells
Hemoglobins

Keywords

  • Cardiac surgery
  • Infections
  • Outcomes
  • Pneumonia
  • Quality improvement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pneumonia after cardiac surgery : Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. / Ailawadi, Gorav; Chang, Helena L.; O'Gara, Patrick T.; O'Sullivan, Karen; Woo, Y. Joseph; DeRose, Joseph; Parides, Michael K.; Thourani, Vinod H.; Robichaud, Sophie; Gillinov, A. Marc; Taddei-Peters, Wendy C.; Miller, Marissa A.; Perrault, Louis P.; Smith, Robert L.; Goldsmith, Lyn; Horvath, Keith A.; Doud, Kristen; Baio, Kim; Gelijns, Annetine C.; Moskowitz, Alan J.; Bagiella, Emilia; Alexander, John H.; Iribarne, Alexander.

In: Journal of Thoracic and Cardiovascular Surgery, 27.07.2016.

Research output: Contribution to journalArticle

Ailawadi, G, Chang, HL, O'Gara, PT, O'Sullivan, K, Woo, YJ, DeRose, J, Parides, MK, Thourani, VH, Robichaud, S, Gillinov, AM, Taddei-Peters, WC, Miller, MA, Perrault, LP, Smith, RL, Goldsmith, L, Horvath, KA, Doud, K, Baio, K, Gelijns, AC, Moskowitz, AJ, Bagiella, E, Alexander, JH & Iribarne, A 2016, 'Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2016.12.055
Ailawadi, Gorav ; Chang, Helena L. ; O'Gara, Patrick T. ; O'Sullivan, Karen ; Woo, Y. Joseph ; DeRose, Joseph ; Parides, Michael K. ; Thourani, Vinod H. ; Robichaud, Sophie ; Gillinov, A. Marc ; Taddei-Peters, Wendy C. ; Miller, Marissa A. ; Perrault, Louis P. ; Smith, Robert L. ; Goldsmith, Lyn ; Horvath, Keith A. ; Doud, Kristen ; Baio, Kim ; Gelijns, Annetine C. ; Moskowitz, Alan J. ; Bagiella, Emilia ; Alexander, John H. ; Iribarne, Alexander. / Pneumonia after cardiac surgery : Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. In: Journal of Thoracic and Cardiovascular Surgery. 2016.
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abstract = "Rationale: Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. Objectives: To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes. Methods: A total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model. Measurements and Main Results: The cumulative incidence of pneumonia was 2.4{\%}, 33{\%} of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95{\%} confidence interval [95{\%} CI], 1.72-4.66; >48 hours HR, 4.67; 95{\%} CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95{\%} CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95{\%} CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95{\%} CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95{\%} CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95{\%} CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95{\%} CI, 10.31-16.58). Conclusions: Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.",
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T2 - Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

AU - Ailawadi, Gorav

AU - Chang, Helena L.

AU - O'Gara, Patrick T.

AU - O'Sullivan, Karen

AU - Woo, Y. Joseph

AU - DeRose, Joseph

AU - Parides, Michael K.

AU - Thourani, Vinod H.

AU - Robichaud, Sophie

AU - Gillinov, A. Marc

AU - Taddei-Peters, Wendy C.

AU - Miller, Marissa A.

AU - Perrault, Louis P.

AU - Smith, Robert L.

AU - Goldsmith, Lyn

AU - Horvath, Keith A.

AU - Doud, Kristen

AU - Baio, Kim

AU - Gelijns, Annetine C.

AU - Moskowitz, Alan J.

AU - Bagiella, Emilia

AU - Alexander, John H.

AU - Iribarne, Alexander

PY - 2016/7/27

Y1 - 2016/7/27

N2 - Rationale: Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. Objectives: To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes. Methods: A total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model. Measurements and Main Results: The cumulative incidence of pneumonia was 2.4%, 33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95% CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95% CI, 10.31-16.58). Conclusions: Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.

AB - Rationale: Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. Objectives: To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes. Methods: A total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model. Measurements and Main Results: The cumulative incidence of pneumonia was 2.4%, 33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95% CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95% CI, 10.31-16.58). Conclusions: Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.

KW - Cardiac surgery

KW - Infections

KW - Outcomes

KW - Pneumonia

KW - Quality improvement

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