Risk factors for sepsis and endocarditis and long-term survival following coronary artery bypass grafting

Ioannis K. Toumpoulis, Constantine E. Anagnostopoulos, Stavros K. Toumpoulis, Joseph DeRose, Daniel G. Swistel

Research output: Contribution to journalArticle

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Abstract

We sought to determine risk factors for sepsis and/or endocarditis (S/E) and to identify their impact on long-term survival after coronary artery bypass grafting (CABG). We studied 3760 consecutive patients who underwent isolated CABG from 1992 to 2002. Patients with CABG without S/E were compared with those who developed S/E. Long-term survival data (mean follow-up 5.2 years) were obtained from the National Death Index. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for S/E was determined by logistic regression analysis and each patient with S/E was matched to one patient without S/E. Thirty-six patients (0.96%) developed S/E. Independent predictors for S/E were increased age (odds ratio [OR] 1.05 per year, 95% Confidence interval [95% CI] 1.00-1.09; p = 0.040) and the development of other major complications after CABG such as deep sternal wound infection (OR 30.80, 95% CI 9.50-99.82; p < 0.001), gastrointestinal complications (OR 19.48, 95% CI 7.14-53.18; p < 0.001), renal failure (OR 15.18, 95% CI 4.42-52.06; p < 0.001), intraoperative stroke (OR 13.11, 95% CI 4.81-35.69; p < 0.001) and respiratory failure (OR 12.95, 95% CI 5.69-29.45; p < 0.001). After adjustment for pre-, intra- and postoperative factors, the adjusted hazard ratio of long-term mortality for patients with S/E was 3.33 (95% CI 2.17-5.10; p < 0.001). There was no difference in 30-day mortality between matched groups (25.0% vs. 19.4% in patients without S/E, p = 0.778), however patients without S/E had better 5-year survival rate (52.7 ± 8.7% vs. 16.2 ± 6.2%; p = 0.0004). We have identified risk factors for S/E following CABG and we found that there was increased mortality in patients with S/E during a 10-year follow-up period.

Original languageEnglish (US)
Pages (from-to)621-627
Number of pages7
JournalWorld Journal of Surgery
Volume29
Issue number5
DOIs
StatePublished - May 2005
Externally publishedYes

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Endocarditis
Coronary Artery Bypass
Sepsis
Survival
Confidence Intervals
Odds Ratio
Mortality
Wound Infection
Proportional Hazards Models
Respiratory Insufficiency
Renal Insufficiency
Research Design
Survival Rate
Logistic Models
Stroke
Regression Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Risk factors for sepsis and endocarditis and long-term survival following coronary artery bypass grafting. / Toumpoulis, Ioannis K.; Anagnostopoulos, Constantine E.; Toumpoulis, Stavros K.; DeRose, Joseph; Swistel, Daniel G.

In: World Journal of Surgery, Vol. 29, No. 5, 05.2005, p. 621-627.

Research output: Contribution to journalArticle

Toumpoulis, Ioannis K. ; Anagnostopoulos, Constantine E. ; Toumpoulis, Stavros K. ; DeRose, Joseph ; Swistel, Daniel G. / Risk factors for sepsis and endocarditis and long-term survival following coronary artery bypass grafting. In: World Journal of Surgery. 2005 ; Vol. 29, No. 5. pp. 621-627.
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AU - DeRose, Joseph

AU - Swistel, Daniel G.

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N2 - We sought to determine risk factors for sepsis and/or endocarditis (S/E) and to identify their impact on long-term survival after coronary artery bypass grafting (CABG). We studied 3760 consecutive patients who underwent isolated CABG from 1992 to 2002. Patients with CABG without S/E were compared with those who developed S/E. Long-term survival data (mean follow-up 5.2 years) were obtained from the National Death Index. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for S/E was determined by logistic regression analysis and each patient with S/E was matched to one patient without S/E. Thirty-six patients (0.96%) developed S/E. Independent predictors for S/E were increased age (odds ratio [OR] 1.05 per year, 95% Confidence interval [95% CI] 1.00-1.09; p = 0.040) and the development of other major complications after CABG such as deep sternal wound infection (OR 30.80, 95% CI 9.50-99.82; p < 0.001), gastrointestinal complications (OR 19.48, 95% CI 7.14-53.18; p < 0.001), renal failure (OR 15.18, 95% CI 4.42-52.06; p < 0.001), intraoperative stroke (OR 13.11, 95% CI 4.81-35.69; p < 0.001) and respiratory failure (OR 12.95, 95% CI 5.69-29.45; p < 0.001). After adjustment for pre-, intra- and postoperative factors, the adjusted hazard ratio of long-term mortality for patients with S/E was 3.33 (95% CI 2.17-5.10; p < 0.001). There was no difference in 30-day mortality between matched groups (25.0% vs. 19.4% in patients without S/E, p = 0.778), however patients without S/E had better 5-year survival rate (52.7 ± 8.7% vs. 16.2 ± 6.2%; p = 0.0004). We have identified risk factors for S/E following CABG and we found that there was increased mortality in patients with S/E during a 10-year follow-up period.

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