Sources of Variation in Hospital-Level Infection Rates After Coronary Artery Bypass Grafting: An Analysis of The Society of Thoracic Surgeons Adult Heart Surgery Database

Likosky, Donald S.; Wallace, Amelia S.; Prager, Richard L.; Jacobs, Jeffrey P.; Zhang, Min; Harrington, Steven D.; Saha-Chaudhuri, Paramita; Theurer, Patricia F.; Fishstrom, Astrid; Dokholyan, Rachel S.; Shahian, David M.; Rankin, J. Scott

doi:10.1016/j.athoracsur.2015.05.015

Cited by 33 publications

(29 citation statements)

References 23 publications

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“…Our study reveals pneumonia to be the most common serious infection post cardiac surgery and this finding is supported by other contemporary studies. 14,21 In a recent analysis of over 19,000 patients, pneumonia was the most common postoperative infection (6%) whereas deep surgical site infections occurred in just 1%. 22 In the present study, pneumonia was associated with an 8.9-fold increased risk of mortality even after adjusting for baseline patient characteristics, and resulted in a 65-day pneumonia mortality rate of 6 per 100 patient-months.…”

Section: Commentmentioning

confidence: 99%

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

Ailawadi

Chang

O’Gara

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

105

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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 post-operative pneumonia and estimate its impact on clinical outcomes. Methods 5,158 adult cardiac surgery patients were prospectively enrolled 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 using a multi-state model. Measurements and Main Results The cumulative incidence of p neumonia 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;HR,2·83; 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 pneumonia risk. 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 LOS 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. Adjusting for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.

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Section: Commentmentioning

confidence: 99%

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

Ailawadi

Chang

O’Gara

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

105

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“…16 Importantly, pneumonia accounted for 60.1% of HAIs in this setting, a finding that was further confirmed using the STS adult cardiac surgery database. 17 …”

Section: Commentmentioning

confidence: 99%

A Preoperative Risk Model for Postoperative Pneumonia After Coronary Artery Bypass Grafting

Strobel

Liang

Zhang

et al. 2016

The Annals of Thoracic Surgery

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Background Post-operative pneumonia is the most prevalent of all hospital-acquired infections following isolated coronary artery bypass grafting (CAB). Accurate prediction of a patient’s risk of this morbid complication is hindered by its low relative incidence. In an effort to support clinical decision-making and quality improvement, we developed a pre-operative prediction model for post-operative pneumonia following CAB. Methods We undertook an observational study of 16,084 patients undergoing CAB between Q3 2011 – Q2 2014 across 33 institutions participating in the Michigan Society of Thoracic and Cardiovascular Surgeons – Quality Collaborative. Variables related to patient demographics, medical history, admission status, comorbid disease, cardiac anatomy and the institution performing the procedure were investigated. Logistic regression via forwards stepwise selection (p < 0.05 threshold) was utilized to develop a risk prediction model for estimating the occurrence of pneumonia. Traditional methods were employed to assess the model’s performance. Results Post-operative pneumonia occurred in 3.30% of patients. Multivariable analysis identified 17 pre-operative factors, including: demographics, laboratory values, comorbid disease, pulmonary and cardiac function, and operative status. The final model significantly predicted the occurrence of pneumonia, and performed well (C-statistic: 0.74). These findings were confirmed via sensitivity analyses by center and clinically important sub-groups. Conclusions We identified 17 readily obtainable pre-operative variables associated with post-operative pneumonia. This model may be used to provide individualized risk estimation and to identify opportunities to reduce a patient’s pre-operative risk of pneumonia through pre-habilitation.

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“…Finally, an outstanding National Institutes of Healthfunded study from the ACSD assessed the risk of a variety of infections in patients undergoing CABG [10]. Previous analyses had focused primarily on predictors of adverse sequelae, but less attention had been given to characterizing hospital-level variability.…”

Section: Outcome Analysis Researchmentioning

confidence: 99%

“…Five ACSD-based articles focused on patient outcomes have made substantial contributions to our understanding of aortic valve [6][7][8] and aortic root operations [9] and the assessment of hospital-acquired infections [10].…”

Section: Outcome Analysis Researchmentioning

confidence: 99%

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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Research

Badhwar

Rankin

Jacobs

et al. 2016

The Annals of Thoracic Surgery

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The Society of Thoracic Surgeons Adult Cardiac Database (ACSD) is an international voluntary effort that is the foundation of our specialty's efforts in clinical performance assessment and quality improvement. Containing nearly 6,000,000 patient records, the ACSD is a robust resource for clinical research. Seven major original publications and four review articles were generated from the ACSD in 2015. The risk-adjusted outcome analyses and quality measures reported in these studies have made substantial contributions to inform daily clinical practice. This report summarizes the ACSD-based research efforts published in 2015.

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Sources of Variation in Hospital-Level Infection Rates After Coronary Artery Bypass Grafting: An Analysis of The Society of Thoracic Surgeons Adult Heart Surgery Database

Cited by 33 publications

References 23 publications

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

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

A Preoperative Risk Model for Postoperative Pneumonia After Coronary Artery Bypass Grafting

The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Research

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