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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2011 August;24(4):207-12
Risk factors for surgical site infections after major cardiac surgery
Tamayo E. 1, Alvarez F. J. 2, Gualis J. 3, Bustamante J. 3, Florez S. 3, Soria S. 1, Lajo C. 1, Eiros J. M. 4, Castrodeza J. 5
1 Department of Anaesthesiology and Reanimation Valladolid University Hospital, Valladolid, Spain
2 Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
3 Department of Cardiac Surgery, ICICOR, Valladolid University Hospital, Valladolid, Spain
4 Department of Microbiology, Valladolid University Hospital, Valladolid, Spain
5 Department of Preventive Medicine and Public Health, Faculty of Medicine, Valladolid University Hospital, Valladolid, Spain
Aim. There is a lack of consensus over which variables or risk factors best predict the incidence of Surgical Site Infections (SSIs) after cardiac surgery. The aim of the present study was to identify factors that may influence the development of this serious complication.
Methods. We conducted a prospective open-cohort study from September 2003 to January 2007. All adult patients scheduled for cardiac valve and/or coronary surgery with mean sternotomy were invited to enrol in the study. We included 838 cardiac surgery patients and grouped them according to whether they developed (study group) or did not develop (controls) SSI. We performed multiple logistic regression analyses with a generalized logit link function and stepwise selection to evaluate risk factors and adjust for potential confounders. Factors with values of p<0.25 were initially tested in the models and factors with a value of p<0.05 were considered further.
Results. SSIs developed in 50 (5.9%) patients; 28 (3.3%) had superficial and deep incision SSIs and 22 (2.6%) had organ-space infections. We evaluated 35 potential risk factors: 22 showed multicollinearity and were not considered further; 13 were included in a multivariate analysis. Three were identified as risk factors for SSI, including a single-dose regime of antibiotic prophylaxis (OR=2.78), blood microorganisms (OR=5.55), and the duration of the ICU stay (OR=1.11).
Conclusion. We have shown the importance of antibiotic prophylaxis (single-doses) and postoperative factors (ICU stay and blood microorganisms) in the development of SSIs associated with cardiac surgery.