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Erschienen in: Infection 4/2012

01.08.2012 | Clinical and Epidemiological Study

Surgical site infections after coronary artery bypass graft surgery: incidence, perioperative hospital stay, readmissions, and revision surgeries

verfasst von: M. Cristofolini, D. Worlitzsch, A. Wienke, R.-E. Silber, M. Borneff-Lipp

Erschienen in: Infection | Ausgabe 4/2012

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Abstract

Purpose

High-tech operations performed in cardiac surgery are associated with an increased risk of surgical site infections. In this study, we investigated if surgical site infections following cardiac surgery influence revision surgeries and patients’ length of stay, and compared the results to German hospital infection surveillance data.

Methods

Over a period of 3 years, 2,621 patients of a cardiac surgery unit were enrolled following cardiac artery bypass graft surgery. Patients were examined for the incidence of surgical site infections, revision surgeries, and length of stay. The results were compared to the National Reference Center (NRC) data retrospectively.

Results

Of the observed population, 4.5 % suffer from surgical site infections, and in 7.7 % of the patients, revision surgery had to be performed. The length of stay was exceeded significantly for the patients with surgical site infections (average stay 14.5 vs. 42.2 days, p < 0.001). Compared to the NRC data, severe surgical site infections were not increased significantly.

Conclusion

Surgical site infections resulted in revision surgeries with a significantly increased inpatient stay. However, this increase did not differ significantly from comparable German university hospitals.
Literatur
1.
Zurück zum Zitat Bitkover CY, Gårdlund B. Mediastinitis after cardiovascular operations: a case–control study of risk factors. Ann Thorac Surg. 1998;65:36–40.PubMedCrossRef Bitkover CY, Gårdlund B. Mediastinitis after cardiovascular operations: a case–control study of risk factors. Ann Thorac Surg. 1998;65:36–40.PubMedCrossRef
2.
Zurück zum Zitat Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, David TE. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg. 1998;65:1050–6.PubMedCrossRef Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, David TE. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg. 1998;65:1050–6.PubMedCrossRef
3.
Zurück zum Zitat Brandt C, Sohr D, Behnke M, Daschner F, Rüden H, Gastmeier P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol. 2006;27:1347–51.PubMedCrossRef Brandt C, Sohr D, Behnke M, Daschner F, Rüden H, Gastmeier P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol. 2006;27:1347–51.PubMedCrossRef
4.
Zurück zum Zitat Braxton JH, Marrin CAS, McGrath PD, Ross CS, Morton JR, Norotsky M, Charlesworth DC, Lahey SJ, Clough RA, O’Connor GT; Northern New England Cardiovascular Disease Study Group. Mediastinitis and long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg. 2000;70:2004–7.PubMedCrossRef Braxton JH, Marrin CAS, McGrath PD, Ross CS, Morton JR, Norotsky M, Charlesworth DC, Lahey SJ, Clough RA, O’Connor GT; Northern New England Cardiovascular Disease Study Group. Mediastinitis and long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg. 2000;70:2004–7.PubMedCrossRef
5.
Zurück zum Zitat Doering LV, Esmailian F, Laks H. Perioperative predictors of ICU and hospital costs in coronary artery bypass graft surgery. Chest. 2000;118:736–43.PubMedCrossRef Doering LV, Esmailian F, Laks H. Perioperative predictors of ICU and hospital costs in coronary artery bypass graft surgery. Chest. 2000;118:736–43.PubMedCrossRef
6.
Zurück zum Zitat Fowler VG Jr, O’Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED. Clinical predictors of major infections after cardiac surgery. Circulation. 2005;112:I358–65.PubMedCrossRef Fowler VG Jr, O’Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED. Clinical predictors of major infections after cardiac surgery. Circulation. 2005;112:I358–65.PubMedCrossRef
7.
Zurück zum Zitat Francel TJ, Kouchoukos NT. A rational approach to wound difficulties after sternotomy: the problem. Ann Thorac Surg. 2001;72:1411–8.PubMedCrossRef Francel TJ, Kouchoukos NT. A rational approach to wound difficulties after sternotomy: the problem. Ann Thorac Surg. 2001;72:1411–8.PubMedCrossRef
8.
Zurück zum Zitat Gastmeier P. Nosocomial infection surveillance and control policies. Curr Opin Infect Dis. 2004;17:295–301.PubMedCrossRef Gastmeier P. Nosocomial infection surveillance and control policies. Curr Opin Infect Dis. 2004;17:295–301.PubMedCrossRef
9.
Zurück zum Zitat Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, Hentschel B, Schmitt DV, Mohr FW, Diegeler A. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg. 2002;50:87–91.PubMedCrossRef Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, Walther T, Hentschel B, Schmitt DV, Mohr FW, Diegeler A. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg. 2002;50:87–91.PubMedCrossRef
10.
Zurück zum Zitat Hannan EL, Racz MJ, Walford G, Ryan TJ, Isom OW, Bennett E, Jones RH. Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA. 2003;290:773–80.PubMedCrossRef Hannan EL, Racz MJ, Walford G, Ryan TJ, Isom OW, Bennett E, Jones RH. Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA. 2003;290:773–80.PubMedCrossRef
11.
Zurück zum Zitat Harrington G, Russo P, Spelman D, Borrell S, Watson K, Barr W, Martin R, Edmonds D, Cocks J, Greenbough J, Lowe J, Randle L, Castell J, Browne E, Bellis K, Aberline M. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft. Infect Control Hosp Epidemiol. 2004;25:472–6.PubMedCrossRef Harrington G, Russo P, Spelman D, Borrell S, Watson K, Barr W, Martin R, Edmonds D, Cocks J, Greenbough J, Lowe J, Randle L, Castell J, Browne E, Bellis K, Aberline M. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft. Infect Control Hosp Epidemiol. 2004;25:472–6.PubMedCrossRef
12.
Zurück zum Zitat Herwaldt LA, Cullen JJ, Scholz D, French P, Zimmerman MB, Pfaller MA, Wenzel RP, Perl TM. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol. 2006;27:1291–8.PubMedCrossRef Herwaldt LA, Cullen JJ, Scholz D, French P, Zimmerman MB, Pfaller MA, Wenzel RP, Perl TM. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol. 2006;27:1291–8.PubMedCrossRef
13.
Zurück zum Zitat Hollenbeak CS, Murphy DM, Koenig S, Woodward RS, Dunagan WC, Fraser VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest. 2000;118:397–402.PubMedCrossRef Hollenbeak CS, Murphy DM, Koenig S, Woodward RS, Dunagan WC, Fraser VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest. 2000;118:397–402.PubMedCrossRef
14.
Zurück zum Zitat Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.PubMedCrossRef Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.PubMedCrossRef
15.
Zurück zum Zitat Jakob HG, Borneff-Lipp M, Bach A, von Pückler S, Windeler J, Sonntag HG, Hagl S. The endogenous pathway is a major route for deep sternal wound infection. Eur J Cardiothorac Surg. 2000;17:154–60.PubMedCrossRef Jakob HG, Borneff-Lipp M, Bach A, von Pückler S, Windeler J, Sonntag HG, Hagl S. The endogenous pathway is a major route for deep sternal wound infection. Eur J Cardiothorac Surg. 2000;17:154–60.PubMedCrossRef
16.
Zurück zum Zitat Kohli M, Yuan L, Escobar M, David T, Gillis G, Comm B, Garcia M, Conly J. A risk index for sternal surgical wound infection after cardiovascular surgery. Infect Control Hosp Epidemiol. 2003;24:17–25.PubMedCrossRef Kohli M, Yuan L, Escobar M, David T, Gillis G, Comm B, Garcia M, Conly J. A risk index for sternal surgical wound infection after cardiovascular surgery. Infect Control Hosp Epidemiol. 2003;24:17–25.PubMedCrossRef
17.
Zurück zum Zitat L’Ecuyer PB, Murphy D, Little JR, Fraser VJ. The epidemiology of chest and leg wound infections following cardiothoracic surgery. Clin Infect Dis. 1996;22:424–9.PubMedCrossRef L’Ecuyer PB, Murphy D, Little JR, Fraser VJ. The epidemiology of chest and leg wound infections following cardiothoracic surgery. Clin Infect Dis. 1996;22:424–9.PubMedCrossRef
18.
Zurück zum Zitat López Gude MJ, San Juan R, Aguado JM, Maroto L, López-Medrano F, Cortina Romero JM, Rufilanchas JJ. Case–control study of risk factors for mediastinitis after cardiovascular surgery. Infect Control Hosp Epidemiol. 2006;27:1397–400.PubMedCrossRef López Gude MJ, San Juan R, Aguado JM, Maroto L, López-Medrano F, Cortina Romero JM, Rufilanchas JJ. Case–control study of risk factors for mediastinitis after cardiovascular surgery. Infect Control Hosp Epidemiol. 2006;27:1397–400.PubMedCrossRef
19.
Zurück zum Zitat Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103:89–95.PubMedCrossRef Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103:89–95.PubMedCrossRef
20.
Zurück zum Zitat Olsen MA, Lock-Buckley P, Hopkins D, Polish LB, Sundt TM, Fraser VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg. 2002;124:136–45.PubMedCrossRef Olsen MA, Lock-Buckley P, Hopkins D, Polish LB, Sundt TM, Fraser VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg. 2002;124:136–45.PubMedCrossRef
21.
Zurück zum Zitat Peterson ED, Coombs LP, Ferguson TB, Shroyer AL, DeLong ER, Grover FL, Edwards FH. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database. Ann Thorac Surg. 2002;74:464–73.PubMedCrossRef Peterson ED, Coombs LP, Ferguson TB, Shroyer AL, DeLong ER, Grover FL, Edwards FH. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database. Ann Thorac Surg. 2002;74:464–73.PubMedCrossRef
22.
Zurück zum Zitat Roy MC, Herwaldt LA, Embrey R, Kuhns K, Wenzel RP, Perl TM. Does the Centers for Disease Control’s NNIS system risk index stratify patients undergoing cardiothoracic operations by their risk of surgical-site infection? Infect Control Hosp Epidemiol. 2000;21:186–90.PubMedCrossRef Roy MC, Herwaldt LA, Embrey R, Kuhns K, Wenzel RP, Perl TM. Does the Centers for Disease Control’s NNIS system risk index stratify patients undergoing cardiothoracic operations by their risk of surgical-site infection? Infect Control Hosp Epidemiol. 2000;21:186–90.PubMedCrossRef
23.
Zurück zum Zitat Rüden H, Daschner F, Schumacher M. Nosokomiale Infektionen in Deutschland: Erfassung und Prävention; (NIDEP-Studie); Teil I: Prävalenz nosokomialer Infektionen; Qualitätssicherung in der Krankenhaushygiene. Hrsg.: Das Bundesministerium für Gesundheit—Baden–Baden, Nomos Verlagsgesellschaft, 1995. Rüden H, Daschner F, Schumacher M. Nosokomiale Infektionen in Deutschland: Erfassung und Prävention; (NIDEP-Studie); Teil I: Prävalenz nosokomialer Infektionen; Qualitätssicherung in der Krankenhaushygiene. Hrsg.: Das Bundesministerium für Gesundheit—Baden–Baden, Nomos Verlagsgesellschaft, 1995.
24.
Zurück zum Zitat Rüden H, Gastmeier P. Rollen und Aufgaben der Hygienefachkräfte und des Krankenhaushygienikers unter besonderer Berücksichtigung von Kosten-Nutzen-Aspekten. Bundesgesundheitsbl—Gesundheitsforsch—Gesundheitsschutz. 2004;47:323-8. Rüden H, Gastmeier P. Rollen und Aufgaben der Hygienefachkräfte und des Krankenhaushygienikers unter besonderer Berücksichtigung von Kosten-Nutzen-Aspekten. Bundesgesundheitsbl—Gesundheitsforsch—Gesundheitsschutz. 2004;47:323-8.
25.
Zurück zum Zitat Russo PL, Spelman DW. A new surgical-site infection risk index using risk factors identified by multivariate analysis for patients undergoing coronary artery bypass graft surgery. Infect Control Hosp Epidemiol. 2002;23:372–6.PubMedCrossRef Russo PL, Spelman DW. A new surgical-site infection risk index using risk factors identified by multivariate analysis for patients undergoing coronary artery bypass graft surgery. Infect Control Hosp Epidemiol. 2002;23:372–6.PubMedCrossRef
26.
Zurück zum Zitat Trick WE, Scheckler WE, Tokars JI, Jones KC, Reppen ML, Smith EM, Jarvis WR. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000;119:108–14.PubMedCrossRef Trick WE, Scheckler WE, Tokars JI, Jones KC, Reppen ML, Smith EM, Jarvis WR. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000;119:108–14.PubMedCrossRef
27.
Zurück zum Zitat Weintraub WS, Jones EL, Craver J, Guyton R, Cohen C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation. 1989;80:276–84.PubMedCrossRef Weintraub WS, Jones EL, Craver J, Guyton R, Cohen C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation. 1989;80:276–84.PubMedCrossRef
Metadaten
Titel
Surgical site infections after coronary artery bypass graft surgery: incidence, perioperative hospital stay, readmissions, and revision surgeries
verfasst von
M. Cristofolini
D. Worlitzsch
A. Wienke
R.-E. Silber
M. Borneff-Lipp
Publikationsdatum
01.08.2012
Verlag
Springer-Verlag
Erschienen in
Infection / Ausgabe 4/2012
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-012-0275-0

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