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

Cardiothoracic Surgical Trials Network (CTSN)

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1555-1562.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Surgical Wound Infection
Coinfection
Coronary Artery Bypass
Cohort Studies
Prospective Studies
Saphenous Vein
Confidence Intervals
Transplants
Anti-Bacterial Agents
Erythrocyte Transfusion
Groin
Gram-Positive Bacteria
Blood Transfusion
Hyperglycemia
Length of Stay
Leg
Body Mass Index
Morbidity

Keywords

  • body mass index
  • coronary artery bypass grafting
  • postoperative length of stay
  • postoperative readmission
  • red blood cell transfusion
  • saphenous vein graft
  • surgical site infection

ASJC Scopus subject areas

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

Cite this

Secondary surgical-site infection after coronary artery bypass grafting : A multi-institutional prospective cohort study. / Cardiothoracic Surgical Trials Network (CTSN).

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 4, 01.04.2018, p. 1555-1562.e1.

Research output: Contribution to journalArticle

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title = "Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study",
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.",
keywords = "body mass index, coronary artery bypass grafting, postoperative length of stay, postoperative readmission, red blood cell transfusion, saphenous vein graft, surgical site infection",
author = "{Cardiothoracic Surgical Trials Network (CTSN)} and Gulack, {Brian C.} and Kirkwood, {Katherine A.} and Wei Shi and Smith, {Peter K.} and Alexander, {John H.} and Burks, {Sandra G.} and Gelijns, {Annetine C.} and Thourani, {Vinod H.} and Daniel Bell and Ann Greenberg and Goldfarb, {Seth D.} and Mayer, {Mary Lou} and Bowdish, {Michael E.} and Miller, {Marissa A.} and Taddei-Peters, {Wendy C.} and Dennis Buxton and Ron Caulder and Geller, {Nancy L.} and David Gordon and Jeffries, {Neal O.} and Albert Lee and Moy, {Claudia S.} and Gombos, {Ilana Kogan} and Jennifer Ralph and Gardner, {Timothy J.} and O'Gara, {Patrick T.} and Gelijns, {Annetine C.} and Parides, {Michael K.} and Ascheim, {Deborah D.} and Moskowitz, {Alan J.} and Ellen Moquete and Rose, {Eric A.} and Melissa Chase and Yingchun Chen and Rosemarie Gagliardi and Lopa Gupta and Edlira Kumbarce and Ron Levitan and Karen O'Sullivan and Milerva Santos and Alan Weinberg and Paula Williams and Carrie Wood and Xia Ye and Michler, {Robert E.} and Joseph DeRose and Goldstein, {Daniel J.} and Jakobleff, {William A.} and Garcia, {Mario J.} and Taub, {Cynthia C.}",
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TY - JOUR

T1 - Secondary surgical-site infection after coronary artery bypass grafting

T2 - A multi-institutional prospective cohort study

AU - Cardiothoracic Surgical Trials Network (CTSN)

AU - Gulack, Brian C.

AU - Kirkwood, Katherine A.

AU - Shi, Wei

AU - Smith, Peter K.

AU - Alexander, John H.

AU - Burks, Sandra G.

AU - Gelijns, Annetine C.

AU - Thourani, Vinod H.

AU - Bell, Daniel

AU - Greenberg, Ann

AU - Goldfarb, Seth D.

AU - Mayer, Mary Lou

AU - Bowdish, Michael E.

AU - Miller, Marissa A.

AU - Taddei-Peters, Wendy C.

AU - Buxton, Dennis

AU - Caulder, Ron

AU - Geller, Nancy L.

AU - Gordon, David

AU - Jeffries, Neal O.

AU - Lee, Albert

AU - Moy, Claudia S.

AU - Gombos, Ilana Kogan

AU - Ralph, Jennifer

AU - Gardner, Timothy J.

AU - O'Gara, Patrick T.

AU - Gelijns, Annetine C.

AU - Parides, Michael K.

AU - Ascheim, Deborah D.

AU - Moskowitz, Alan J.

AU - Moquete, Ellen

AU - Rose, Eric A.

AU - Chase, Melissa

AU - Chen, Yingchun

AU - Gagliardi, Rosemarie

AU - Gupta, Lopa

AU - Kumbarce, Edlira

AU - Levitan, Ron

AU - O'Sullivan, Karen

AU - Santos, Milerva

AU - Weinberg, Alan

AU - Williams, Paula

AU - Wood, Carrie

AU - Ye, Xia

AU - Michler, Robert E.

AU - DeRose, Joseph

AU - Goldstein, Daniel J.

AU - Jakobleff, William A.

AU - Garcia, Mario J.

AU - Taub, Cynthia C.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

KW - body mass index

KW - coronary artery bypass grafting

KW - postoperative length of stay

KW - postoperative readmission

KW - red blood cell transfusion

KW - saphenous vein graft

KW - surgical site infection

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DO - 10.1016/j.jtcvs.2017.10.078

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