Postoperative surgical site infections in cardiac surgery —an overview of preventive measures

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95% CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95% CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95% CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

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Routine Surveillance Versus Independent Assessment by an Outcome Adjudication Committee in Assessing Patients for Sternal Surgical Site Infections After Cardiac Surgery

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv133.236 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Author(s):

Dominik Mertz ◽

Richard Whitlock ◽

Stephanie Smith ◽

Alex Carignan ◽

Muhammad Rehan ◽

...

Keyword(s):

Cardiac Surgery ◽

Surgical Site Infections ◽

Routine Surveillance ◽

Independent Assessment ◽

Adjudication Committee ◽

Outcome Adjudication

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Violation of prophylactic vancomycin administration timing is a potential risk factor for rate of surgical site infections in cardiac surgery patients: a prospective cohort study

BMC Cardiovascular Disorders ◽

10.1186/s12872-017-0506-5 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 9

Author(s):

Paolo Cotogni ◽

Cristina Barbero ◽

Roberto Passera ◽

Lucina Fossati ◽

Giorgio Olivero ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Cohort Study ◽

Prospective Cohort Study ◽

Potential Risk ◽

Prospective Cohort ◽

Surgical Site Infections ◽

Potential Risk Factor ◽

Administration Timing

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Parent education discharge instruction program for care of children at home after cardiac surgery in Southern India

Cardiology in the Young ◽

10.1017/s1047951115002462 ◽

2015 ◽

Vol 26 (6) ◽

pp. 1213-1220 ◽

Cited By ~ 5

Author(s):

Sandra L. Staveski ◽

V. P. Parveen ◽

Sai B. Madathil ◽

Susan Kools ◽

Linda S. Franck

Keyword(s):

Cardiac Surgery ◽

Home Care ◽

Parent Education ◽

Medical Condition ◽

Child Outcomes ◽

Hospital Costs ◽

Surgical Site Infections ◽

Discharge Instruction ◽

Quasi Experimental ◽

High Level

AbstractIntroductionIn many developing countries, children with CHD are now receiving surgical repair or palliation for their complex medical condition. Consequently, parents require more in-depth discharge education programmes to enable them to recognise complications and manage their children’s care after hospital discharge. This investigation evaluated the effectiveness of a structured nurse-led parent discharge teaching programme on nurse, parent, and child outcomes in India.Materials and methodsA quasi-experimental investigation compared nurse and parent home care knowledge before and at two time points after the parent education discharge instruction program’s implementation. Child surgical-site infections and hospital costs were compared for 6 months before and after the discharge programme’s implementation.ResultsBoth nurses (n=63) and parents (n=68) participated in this study. Records of 195 children who had undergone cardiac surgery were reviewed. Nurses had a high-level baseline home care knowledge that increased immediately after the discharge programme’s implementation (T1=24.4±2.89; T2=27.4±1.55; p<0.005; 30 point scale), but decreased to near baseline (T3=23.8±3.4; ns) 4 months after the programme’s implementation. Nurse teaching documentation increased by 56% after the programme’s implementation. Parent knowledge scores increased from 1.76±1.4 for Cohort 1 to 3.68±0.852 for Cohort 2 (p<0.005; 0–4 scale) after the discharge programme’s implementation. Surgical-site infections decreased from 27% in Cohort 1 to 2% in Cohort 2 (p>0.05) after the programme’s implementation.ConclusionNurse, parent, and child outcomes were improved after implementation of the structured nurse-led parent discharge programme for parents in India. Structured nurse-led parent discharge programmes may help prepare parents to provide better home care for their children after cardiac surgery. Further investigation of causality and influencing factors is warranted.

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Hyperglycemic Episodes Are Associated With Postoperative Infections After Cardiac Surgery

Scandinavian Journal of Surgery ◽

10.1177/1457496917731190 ◽

2017 ◽

Vol 107 (2) ◽

pp. 138-144 ◽

Cited By ~ 3

Author(s):

K. M. Järvelä ◽

N. K. Khan ◽

E. L. Loisa ◽

J. A. Sutinen ◽

J. O. Laurikka ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Glucose ◽

Surgical Site Infections ◽

Infectious Complications ◽

Target Range ◽

Deep Sternal Wound Infection ◽

Postoperative Infections ◽

Glucose Levels ◽

Arterial Blood ◽

Blood Glucose Levels

Background and Aims: To describe the incidence of and risk factors for postoperative infections and the correlation between postoperative hyperglycemia despite tight blood glucose control with infectious and other complications after contemporary cardiac surgery. Material and Methods: The study comprised 1356 consecutive adult patients who underwent cardiac surgery between January 2013 and December 2014 and were followed up for 6 months. Patients surviving the first 2 days were included in the analysis. Preoperative demographic information, medical history, procedural details, and the postoperative course were recorded. The target range for blood glucose levels was 4–7 mmol/L and repeated arterial blood samples were obtained during the intensive care unit stay. The associations of blood glucose levels during the first postoperative day and the occurrence of postoperative infections and other significant complications were analyzed. Results: Of the study cohort, 9.8% developed infectious complications which were classified as major surgical site infections in 2.2%, minor surgical site infections in 1.1%, lung infections in 2.0%, unclear fever or bacteremia in 0.3%, cannula or catheter related in 2.6%, multiple in 1.5%, and other in 0.2%. The incidence of deep sternal wound infection was 2.0%. Repeated hyperglycemia occurred in 39.7% of patients and was associated with increased rates of postoperative infections, 12.1% versus 8.2%, p = 0.019; stroke, 4.9% versus 1.5%, p < 0.001; and mortality, 6.1% versus 2.1%, p < 0.001, when compared to patients with single or no hyperglycemia. Conclusion: Every 10th patient develops infectious complications after cardiac surgery. Repeated hyperglycemia is associated with increased rates of infectious complications, stroke, and mortality.

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