Increase in the Rate of Sternal Surgical Site Infection After Coronary Artery Bypass Graft: A Marker of Higher Severity of Illness

2007 ◽  
Vol 28 (6) ◽  
pp. 655-660 ◽  
Author(s):  
Mohamad G. Fakih ◽  
Mamta Sharma ◽  
Riad Khatib ◽  
Dorine Berriel-Cass ◽  
Susan Meisner ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Severity Of Illness ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Peripheral Vascular ◽  
Duration Of Surgery

Objective.To evaluate factors related to a gradual rise in sternal surgical site infection (SSI) rates.Design.Retrospective cohort study.Setting.A 608-bed, tertiary care teaching hospital.Patients.All patients who underwent coronary artery bypass graft (CABG) from January 2000 through September 2004.Results.Of 3,578 patients who underwent CABG, 144 (4%) had sternal SSI. There was an increase in infection rate, with a marked reduction in the number of operations per year. The percentage of patients with peripheral vascular disease increased from 12% to 24.3% (P < .001), and the percentage with congestive heart failure increased from 17% to 22% (P < .001). Between 2002 and 2004, the mean duration of surgery increased from 233 to 290 minutes (P < .001), the percentage of patients with a National Nosocomial Infections Surveillance System (NNIS) risk index of 2 increased from 14.3% to 38% (P < .001), and the percentage of patients with a postoperative stay in the intensive care unit of greater than 72 hours increased from 29% to 40.6% (P < .001). Multivariate analysis showed diabetes mellitus, peripheral vascular disease, obesity, duration of surgery, and postoperative stay in the intensive care unit of greater than 72 hours to be independently associated with infection.Conclusions.An increase in infection in the CABG population not associated with an outbreak may be a reflection of a change in the severity of illness. Preoperative, intraoperative, and postoperative markers for increased infection risk may be used, in addition to the NNIS risk index, to assess the patient population risk.

scholarly journals Post-operative ventilatory nursing regime of research coronary artery bypass graft patients

1999 ◽  
Vol 4 (4) ◽  
pp. 29-36
Author(s):  
H Potgieter ◽  
H Uys ◽  
W E Nel
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Full Text ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Independent Practitioner

The nurse working in the intensive care unit functions as an independent practitioner under the Nursing Act and arising SANC regulations. OpsommingDie doel van hierdie navorsing is om die invloed van 'n pre-operatiewe bloedgasanalise op die post-operatiewe ventilatoriese verplegingsregime van 'n koronere vatomleidingspasient te bepaal. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

A New Surgical-Site Infection Risk Index Using Risk Factors Identified by Multivariate Analysis for Patients Undergoing Coronary Artery Bypass Graft Surgery

2002 ◽  
Vol 23 (7) ◽  
pp. 372-376 ◽  
Author(s):  
Philip L. Russo ◽  
Denis W. Spelman
Keyword(s):  
Risk Factors ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Risk Indices ◽  
Alfred Hospital ◽  
System Risk ◽  
G Value

Objectives:To develop a new, simple, and practical risk index for patients undergoing coronary artery bypass graft (CABG) surgery, to develop a preoperative risk index that is predictive of surgical-site infection (SSI), and to compare the new risk indices with the National Nosocomial Infections Surveillance (NNIS) System risk index.Design:Potential risk factor and infection data were collected prospectively and analyzed by multivariate analysis. Two new risk indices were constructed and then compared with the NNIS System risk index for predictive power for SSI.Setting:Alfred Hospital is a 350-bed, university-affiliated, tertiary-care referral center. The cardiothoracic unit performs approximately 650 CABG procedures per year.Patients:All patients undergoing CABG surgery within the cardiothoracic unit at Alfred Hospital between December 1, 1996, and September 29, 2000, were included.Results:Potential risk factor data were complete for 2,345 patients. There were 199 SSIs. Obesity (odds ratio [OR], 1.78; 95% confidence interval [CI95], 1.24 to 2.55), peripheral or cerebrovascular disease (OR, 1.64; CI95, 1.16 to 2.33), insulin-dependent diabetes mellitus (OR, 2.29; CI95, 1.15 to 4.54), and a procedure lasting longer than 5 hours (OR, 1.75; CI95,1.18 to 2.58) were identified as independent risk factors for SSI. With the use of a different combination of these risk factors, two risk indices were constructed and compared using the Goodman-Kruskal nonparametric correlation coefficient (G). Risk index B had the highest G value (0.3405; CI95, 0.2245 to 0.4565), compared with the NNIS System risk index G value (0.3142; CI95, 0.1462 to 0.4822). The G value for risk index A constructed from preoperative variables only, was 0.3299 (CI95 0.2039 to 0.4559).Conclusion:Two new risk indices have been developed. Both indices are as predictive as the NNIS System risk index. One of the new risk indices can also be applied preoperatively.

Admission-Specific Chronic Disease Scores as Alternative Predictors of Surgical Site Infection for Patients Undergoing Coronary Artery Bypass Graft Surgery

2006 ◽  
Vol 27 (08) ◽  
pp. 802-808 ◽  
Author(s):  
Ruth Batista ◽  
Keith Kaye ◽  
Deborah S. Yokoe
Keyword(s):  
Chronic Disease ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Site Infection ◽  
Artery Bypass Graft ◽  
Disease Score ◽  
Chronic Disease Score ◽  
Study Participants

Objective.To evaluate the admission chronic disease score (ACDS) and a variant of the ACDS as predictors of surgical site infection (SSI) for study participants who underwent coronary artery bypass graft (CABG) surgery.Design.Retrospective case-control study.Setting.A 750-bed academic medical center.Participants.All participants with an SSI that was identified through hospital-based surveillance (defined as case patients) and a random sample of participants without SSI following CABG surgery (defined as control subjects) between July 1, 1999, and June 30, 2001.Results.An ACDS based on medications ordered on the day of hospital admission was determined for 264 study participants admitted prior to the day of the surgical procedure. A preadmission chronic disease score (PACDS) based on outpatient medications was calculated for 281 participants, using the record of preadmission medications in the patient's discharge summary. The ACDS and PACDS were significantly higher for case patients, compared with control subjects (P= .03 andP= .05, respectively). American Society of Anesthesiologists (ASA) score and the standard National Nosocomial Infection Surveillance system (NNIS) risk index were not significant predictors of SSI. In logistic regression models, only the ACDS (odds ratio, 1.02 per 100 ACDS points), the PACDS (odds ratio, 1.02 per 100 PACDS points), the highest PACDS quintile (odds ratio, 2.89 [compared with lowest quintile]), and a modified NNIS-PACDS score of 2 (odds ratio, 3.5 [compared with a score of 0]) were significant predictors of SSI.Conclusions.Because preoperative medications are likely to reflect comorbidities that influence the risk of SSI, medication-based scoring systems such as the ACDS and PACDS may allow for better risk stratification than the standard NNIS risk index, particularly for patient populations with relatively homogenous wound classification and ASA score distributions.

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