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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 155; no. 4; pp. 1555 - 1562.e1
• Main Authors: Gulack, Brian C., Shi, Wei, Gelijns, Annetine C., Thourani, Vinod H., Greenberg, Ann, Goldfarb, Seth D., Mayer, Mary Lou, Miller, Marissa A., Taddei-Peters, Wendy C., Buxton, Dennis, Caulder, Ron, Geller, Nancy L., Jeffries, Neal O., Moy, Claudia S., Gombos, Ilana Kogan, Ralph, Jennifer, Gardner, Timothy J., Parides, Michael K., Ascheim, Deborah D., Moskowitz, Alan J., Rose, Eric A., Chase, Melissa, Gagliardi, Rosemarie, Gupta, Lopa, Santos, Milerva, Wood, Carrie, Ye, Xia, Blackstone, Eugene H., Gillinov, A. Marc, Lackner, Pamela, Berroteran, Leoma, Dolney, Diana, Fleming, Suzanne, Palumbo, Roberta, Whitman, Christine, Sankovic, Kathy, Pattakos, Gregory, Clarke, Pamela A., Williams, Mathew, Smith, Craig R., Naka, Yoshifumi, Schwartz, Allan, Bell, Daniel, Van Patten, Danielle, Welsh, Stacey, Alexander, John H., Milano, Carmelo A., Glower, Donald D., Mathew, Joseph P., Berry, Mark F., Tong, Betty C., Williams, Judson B., Ferguson, T. Bruce, Kypson, Alan P., Rodriguez, Evelio, Akers, Brenda, Puskas, John D., Guyton, Robert, Baio, Kim, D'Alessandro, David A., Bello, Ricardo, Garcia, Mario, Spevak, Daniel, Swayze, Roger, Perrault, Louis P., Basmadjian, Arsène-Joseph, Bouchard, Denis, Carrier, Michel, Pellerin, Michel, El-Hamamsy, Ismael, Denault, André, Robichaud, Sophie, Siegenthaler, Michael P., Murphy, Mandy, Iraola, Margaret, Acker, Michael A., Woo, Y. Joseph, Johnston, Karen, Dent, John M., Sandra Burks, Jessica Keim, Gahring, Kim, Bull, David A., Desvigne-Nickens, Patrice, Dixon, Dennis O., Haigney, Mark, Holubkov, Richard, Miller, Frank, Murkin, John M., McDonald, Cheryl L., Byington, Robert, Ikonomidis, John S., Yancy, Clyde W., Fang, James C., Richenbacher, Wayne, Rao, Vivek, Miller, Rachel, Pinney, Sean
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Body Mass Index; Coronary Artery Bypass - adverse effects; coronary artery bypass grafting; Erythrocyte Transfusion - adverse effects; Female; Humans; Incidence; Length of Stay; Male; Middle Aged; Patient Readmission; postoperative length of stay; postoperative readmission; Prospective Studies; red blood cell transfusion; Risk Assessment; Risk Factors; Saphenous Vein - transplantation; saphenous vein graft; surgical site infection; Surgical Wound Infection - diagnosis; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Surgical Wound Infection - therapy; Time Factors; Tissue and Organ Harvesting - adverse effects; Treatment Outcome; United States - epidemiology; United States; saphenous vein graft; SVG; body mass index; CI; PRBC; surgical site infection; SSI; postoperative readmission; HR; IQR; red blood cell transfusion; CTSN; CABG; postoperative length of stay; coronary artery bypass grafting; BMI
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2017.10.078

To analyze patient risk factors and processes of care associated with secondary surgical-site infection (SSI) after coronary artery bypass grafting (CABG). 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. 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. 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.