TY - JOUR
T1 - Pneumonia after cardiac surgery
T2 - Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network
AU - Ailawadi, Gorav
AU - Chang, Helena L.
AU - O'Gara, Patrick T.
AU - O'Sullivan, Karen
AU - Woo, Y. Joseph
AU - DeRose, Joseph J.
AU - Parides, Michael K.
AU - Thourani, Vinod H.
AU - Robichaud, Sophie
AU - Gillinov, A. Marc
AU - Taddei-Peters, Wendy C.
AU - Miller, Marissa A.
AU - Perrault, Louis P.
AU - Smith, Robert L.
AU - Goldsmith, Lyn
AU - Horvath, Keith A.
AU - Doud, Kristen
AU - Baio, Kim
AU - Gelijns, Annetine C.
AU - Moskowitz, Alan J.
AU - Bagiella, Emilia
AU - Alexander, John H.
AU - Iribarne, Alexander
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
PY - 2017/6
Y1 - 2017/6
N2 - 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 postoperative pneumonia and estimate its impact on clinical outcomes. Methods A total of 5158 adult cardiac surgery patients were enrolled prospectively 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 by a multistate model. Measurements and Main Results The cumulative incidence of pneumonia 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; hazard ratio [HR], 2.83; 95% confidence interval [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 the risk of pneumonia. 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 length of stay 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. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.
AB - 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 postoperative pneumonia and estimate its impact on clinical outcomes. Methods A total of 5158 adult cardiac surgery patients were enrolled prospectively 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 by a multistate model. Measurements and Main Results The cumulative incidence of pneumonia 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; hazard ratio [HR], 2.83; 95% confidence interval [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 the risk of pneumonia. 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 length of stay 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. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.
KW - cardiac surgery
KW - infections
KW - outcomes
KW - pneumonia
KW - quality improvement
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U2 - 10.1016/j.jtcvs.2016.12.055
DO - 10.1016/j.jtcvs.2016.12.055
M3 - Article
C2 - 28341473
AN - SCOPUS:85015718747
SN - 0022-5223
VL - 153
SP - 1384-1391.e3
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -