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Predictors of infection in post-coronary artery bypass graft surgery
Priscila Ledur1, Lúcia Almeida, Lucia Campos Pellanda
1Institute of Cardiology of Rio Grande do Sul / University Foundation of Cardiology (IC / FUC), Porto Alegre, Brazil.
Insights
Diabetes and prolonged central venous catheter use are key predictors of post-coronary artery bypass grafting (CABG) infection. Preoperative blood glucose levels did not significantly predict infection risk in CABG patients.
Area of Science:
- Cardiology
- Infectious Disease
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a vital treatment for severe arterial disease.
- Post-CABG infections represent a significant complication, impacting patient recovery and outcomes.
Purpose of the Study:
- To investigate the incidence of post-CABG infections.
- To identify clinical predictors associated with infection development in patients undergoing CABG.
Main Methods:
- A cohort study was conducted involving patients who underwent CABG between January 2004 and February 2006.
- Exclusion criteria included emergency surgery, missing preoperative glucose levels, and pre-existing infections.
- Statistical analyses included Student's t test, chi-square, and logistic regression.
Main Results:
- Out of 717 patients, 19.1% developed infections, predominantly respiratory (62%).
- Diabetes (OR 4.18) and prolonged central venous catheter use (OR 1.019) were significant predictors of infection.
- Cardiac catheterism (OR 2.03) also emerged as a predictor, while preoperative glucose levels were not associated with increased infection risk.
Conclusions:
- Diabetes mellitus and extended duration of central venous catheter use are independently associated with an increased risk of infection following CABG.
- Preoperative blood glucose levels are not a reliable predictor of post-CABG infection risk.
- Further research into perioperative glycemic control is warranted to mitigate infection rates.
Background:
Although coronary artery bypass grafting (CABG) is a good alternative therapy in severe arterial disease, it may evolve with complications, especially infections.
Objectives:
To determine the incidence of infection in post-CABG and its clinical predictors in a cardiology reference center in Brazil.
Methods:
Cohort study. Data were collected from all patients undergoing CABG between January/2004 and February/2006, excluding emergency surgery, absent record of glucose blood levels preoperatively and infection prior to surgery.
Statistical Analysis:
Student's t test, chi square, logistic regression.
Results:
We evaluated 717 patients, 61.9 ± 11 years old, 67.1% were men, 29.6% with diabetes, of whom 137 (19.1%) developed infection (62% respiratory, 25% superficial wound, 9.5% urinary, 3.6% deep wound). Diabetes was more prevalent in those who developed infection, as well as prolonged time of indwelling central venous catheter (79.3 ± 40.5 vs. 61.0 ± 19.3 hours, P<0.001). After multivariate analysis (model adjusted for dyslipidemia, hypertension, smoking and leukocytes), both diabetes (OR 4.18 [2.60-6.74]), prolonged central venous line (OR 1.019 [1.00-1.02] and cardiac catheterism (OR 2.03 [1.14-3.60] remained predictors of infection. While diabetes is associated with a higher percentage of infections (P <0.001), preoperative serum glucose was not associated with increased risk of infection.
Conclusions:
Diabetes and permanence of central venous catheters were associated with development of infection in post-CABG. The preoperative blood glucose was not a predictor of risk of infection. It is probably necessary to study with greater detail glycemic control trans- and post-operatively.
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