Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica

Ledur, Priscila dos Santos; Almeida, Lúcia Freitas; Pellanda, Lúcia Campos; Schaan, Beatriz D’Agord

doi:10.1590/s0102-76382011000200008

Cited by 20 publications

(19 citation statements)

References 27 publications

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“…Brazilian studies observed association of diabetes with general infections in the post-operative period [10], (20) 5 (3.6) 5 (3.6) 3 (2.1) 3 (2.1) 2 (1.4) 2 (1.4) 1 (0.7) 1 (0.7) CABG -coronary artery bypass graft Fig. 1 sternal wound infection [11] and mediastinitis [12,13].…”

Section: Discussionmentioning

confidence: 99%

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

Júnior¹,

Pereira²,

Valle³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Introduction: Diabetes is a well known risk factor for early and late adverse outcomes in patients undergoing coronary artery bypass graft surgery (CABG); however, few studies have investigated the impact of this risk factor in the group of older patients, especially octogenarians.Objectives: To compare in-hospital mortality and morbidity of diabetic and nondiabetic patients aged ≥ 80 years submitted to CABG.Methods: A total of 140 consecutive cases were studied, of whom 37 (26.4%) were diabetics, in a retrospective crosssectional study, that included all patients aged ≥ 80 years submitted to isolated/associated CABG. The patients' mean age was 82.5 ± 2.2 years and 55.7% were males.Results: The hospital mortality rate did not significantly differ in multivariate analysis: 16.2% diabetic x 13.6% nondiabetic (P = 0.554), as well as morbidity: 43.2% x 37.9%, respectively (P = 0.533). Regarding to operative morbidity, the occurrence of stroke was significantly higher in diabetic patients in the univariate analysis (10.8% x 1.9%, P = 0.042). In multivariate analysis, however, the incidence of stroke was not associated with the presence of diabetes (P = 0.085), but it was associated with atrial fibrillation (P = 0.044). There was no significant difference related to other complications.Conclusion: In this small consecutive retrospectively analyzed series, there was no significant increase in hospital mortality and morbidity related to diabetes for CABG in octogenarian patients. The impact of the results of this study is limited by the sample size and might be confirmed by future randomized clinical trials.Descriptors: Myocardial revascularization. Aged. Aged, 80 and over. Diabetes mellitus. ResumoIntrodução: O diabetes é um fator de risco conhecido para eventos adversos precoces e tardios em pacientes submetidos à cirurgia de revascularização miocárdica (CRM); entretanto, poucos estudos investigaram sua influência no grupo de pacientes mais idosos, especialmente nos octogenários.Objetivos: Comparar a mortalidade e a morbidade hospitalar de pacientes com idade ≥ 80 anos diabéticos e não-diabéticos submetidos à CRM. 601Rev Bras Cir Cardiovasc 2012;27(4):600-6 Pivatto Júnior F, et al. -Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?Métodos: Foram estudados 140 casos consecutivos, sendo 37 (26,4%) diabéticos, em um estudo transversal retrospectivo incluindo todos os pacientes com idade ≥ 80 anos submetidos à CRM isolada/associada. A idade média dos pacientes foi de 82,5 ± 2,2 anos e 55,7% eram do sexo masculino.Resultados: A taxa de mortalidade hospitalar não diferiu de maneira significativa na análise multivariada entre os grupos, 16,2% diabéticos x 13,6% não-diabéticos (P=0,554), assim como a morbidade pós-operatória, 43,2 x 37,9%, respectivamente (P=0,533). Em relação à morbidade, a ocorrência de acidente vascular cerebral foi significativamente maior em pacientes diabéticos na análise univariada (10,8% x 1,9%; P = 0,042). Na a...

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Section: Discussionmentioning

confidence: 99%

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

Júnior¹,

Pereira²,

Valle³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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“…The authors found that pneumonia and BSI were risk factors for mortality, although, as in the present study, SSI was not. ledur et al 15 found that prolonged central line use was one of the predictors of postoperative infection after surgical myocardial revascularization (Or 1.02; 95% CI 1.00-1.02; P < 0.001).…”

Section: Almentioning

confidence: 99%

Healthcare-associated infections in the postoperative period after cardiac surgery

Andrioli

Cavalheiro

Furtado

et al. 2018

Int. j. infect. control

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This study aimed to determine the incidence of healthcare-associated infections (HaIs) in patients undergoing cardiac surgery, analyzing data and clinical outcomes in patients with and without HaIs.This was a prospective cohort study involving 293 consecutive adult patients undergoing cardiac surgery between april 2011 and October 2012. Of the 293 patients, 60 (24.9%) developed 73 HaIs: 24 surgical site infections, 24 pneumonias, 14 urinary tract infections (UTIs), and 11 bloodstream infections (BSIs). The incidence of ventilator-associated pneumonia was 14.6 cases/1,000 ventilator-days, whereas that of catheterassociated UTI was 7.15 cases/1,000 catheter-days and that of central line-associated BSI was 4.52 cases/1,000 central line-days. Of the 60 patients with HaIs, 20 (33%) died before postoperative day 90, compared with 18 (7.7%) of the 233 patients without HaIs (P < .001). Independent variables associated with infection were length of hospital stay (Or 1.04; 95% C, 1.01-1.06; P = 0.002), duration of urinary catheter use (Or 1.19; 95% CI 1.07-1.13; P = 0.001), and duration of central line use (Or 1.07; 95% CI 1.01-1.13; P = 0.032). Independent variables associated with mortality were acute Physiology and Chronic Health Evaluation II score (Or 1.27; 95% CI 1.14-1.42; P < 0.001), pneumonia (Or 11.94; 95% CI 3.83-37.17; P < 0.001), UTI (Or 8.59; 95% CI 1.91-38.7; P = 0.005), and BSI (Or 6.16; 95% CI 1.08-34.98; P = 0.040).Int J Infect Control 2018, v14:il

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“…По данным разных авторов, послеоперационная когнитивная дисфункция (ПОКД) встречается от 5 до 80 % в послеопе-рационном периоде КШ [7,15,34,45,56,59]. Однако до на-стоящего времени не сложилось единого мнения о частоте неврологических осложнений после операций на сердце в условиях искусственного кровообращения (ИК).…”

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“…Изначально СВР является естественным адаптационным механизмом с участием гуморальных и клеточных компонентов воспаления, а в последующем становится патологической [26,45].…”

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“…С нейропротективной целью применяются препараты различных групп, в основе действия которых лежит регуля-ция различных звеньев патогенеза нейронального апоптоза, антагонисты NMDA-рецепторов (мемантин), ингибиторы NO-синтетазы (L-нитроаргинин), барбитураты, анесте-зирующие препараты, высокие дозы стероидов, ингиби-тор ксантиноксидазы аллопуринол, диуретик маннитол, антагонисты кальция, β-адреноблокаторы, ингибитор про-теолитических ферментов апротинин, антиконвульсанты [13,16,38,45]. На этапе легких и умеренных когнитивных нарушений приоритетны препараты, улучшающие цере-бральную микроциркуляцию и нейрометаболические про-цессы, а также воздействующие на дофаминергическую и норадренергическую нейротрансмиттерные системы (пирибедил) [12].…”

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Cognitive Impairments in Patients Undergoing Coronary Bypass Surgery Under Artificial Circulation

Петрова¹,

Прокопенко²,

Eremina³

et al. 2015

SMR

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Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica

Abstract: Rev Bras Cir Cardiovasc 2011;26(2):190-6

Cited by 20 publications

References 27 publications

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

Healthcare-associated infections in the postoperative period after cardiac surgery

Cognitive Impairments in Patients Undergoing Coronary Bypass Surgery Under Artificial Circulation

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