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Observational Study
. 2018 Apr;155(4):1555-1562.e1.
doi: 10.1016/j.jtcvs.2017.10.078. Epub 2017 Dec 6.

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

Brian C Gulack  1 , Katherine A Kirkwood  2 , Wei Shi  2 , Peter K Smith  1 , John H Alexander  3 , Sandra G Burks  4 , Annetine C Gelijns  5 , Vinod H Thourani  6 , Daniel Bell  7 , Ann Greenberg  8 , Seth D Goldfarb  2 , Mary Lou Mayer  9 , Michael E Bowdish  10 ; Cardiothoracic Surgical Trials Network (CTSN)
Collaborators, Affiliations
Observational Study

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

Brian C Gulack et al. J Thorac Cardiovasc Surg. 2018 Apr.

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.

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Conflict of interest statement

Conflicts of Interest: All authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
CONSORT diagram
Figure 2
Figure 2
Cumulative incidence of secondary SSI of the leg or groin in patients undergoing CABG with saphenous vein harvesting by time from index procedure.
Figure 3
Figure 3
Factors associated with the development of a secondary SSI of the leg or groin in patients undergoing CABG with saphenous vein harvesting after multivariable adjustment.
See this image and copyright information in PMC

Comment in

References

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