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Observational Study
. 2017 Jun;153(6):1384-1391.e3.
doi: 10.1016/j.jtcvs.2016.12.055. Epub 2017 Feb 9.

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

Gorav Ailawadi  1 , Helena L Chang  2 , Patrick T O'Gara  3 , Karen O'Sullivan  2 , Y Joseph Woo  4 , Joseph J DeRose Jr  5 , Michael K Parides  2 , Vinod H Thourani  6 , Sophie Robichaud  7 , A Marc Gillinov  8 , Wendy C Taddei-Peters  9 , Marissa A Miller  9 , Louis P Perrault  7 , Robert L Smith  10 , Lyn Goldsmith  11 , Keith A Horvath  12 , Kristen Doud  13 , Kim Baio  6 , Annetine C Gelijns  14 , Alan J Moskowitz  2 , Emilia Bagiella  2 , John H Alexander  15 , Alexander Iribarne  16
Affiliations
Observational Study

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

Gorav Ailawadi et al. J Thorac Cardiovasc Surg. 2017 Jun.

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.

Keywords: cardiac surgery; infections; outcomes; pneumonia; quality improvement.

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Conflict of interest statement

Conflicts of Interest: Dr. Gillinov reports personal fees from Edwards Lifesciences, personal fees from Medtronic, personal fees from On-X, grants and personal fees from St. Jude Medical, personal fees from Abbott, personal fees and other from AtriCure, personal fees from ClearFlow, outside the submitted work. Dr. Alexander reports grants from National Institutes of Health/NHLBI, during the conduct of the study. Dr. Smith reports grants from NIH/CTSN , during the conduct of the study; personal fees from Abbott Vascular, personal fees from Edwards Lifesciences, grants from Edwards Lifesciences, personal fees from St Jude , outside the submitted work. All other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Cumulative incidence function with 95% confidence intervals for pneumonia with death as a competing risk.(A) Extended Kaplan-Meier curve with 95% confidence intervals for mortality based on method of Snappin and colleagues.(B). Central Picture with legend: Cumulative incidence of pneumonia over 65 days
Figure 2
Figure 2. Distribution of Identified Microorganisms among Patients Developing Pneumonia
Organism data were available for 62% of pneumonia cases. Up to different three organisms was recorded for each event. Other category: Neisseria sicca, Alcaligenes xylosoxidans, Corynebacterium pseudodiptheriticum, Morganella morganii, Serratia plymuthica
See this image and copyright information in PMC

Comment in

References

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