Contact Isolation Precautions are Associated With Increased Complications and Failure to Rescue After Cardiac Surgery

Contact isolation (CI) refers to a set of practices intended to reduce the transmission of infectious organisms. Previous literature suggests that CI can have a negative effect on direct patient care by discouraging frequent patient-provider contact; however, it is unknown how CI affects the care of postoperative cardiac surgery patients. Our aim was to characterize the outcomes of patients in CI following cardiac surgery.

All patients undergoing cardiac surgery at our institution from 2011 to 2022 were included. This cohort was stratified into two groups: postoperativeCI and no CI (non-CI). Due to limitations in available data, we were unable to determine whether CI was implemented for colonization or active infection. In order to account for pre- and intraoperative differences, CI patients were propensity score matched to non-CI patients. Covariates chosen for matching included Society of Thoracic Surgeons predicted risk of mortality, intraoperative blood product requirement, cross-clamp times, total operating room time, and cardiopulmonary bypass times. Univariate analysis of the matched cohort analyzed the relationship between CI and postoperative outcomes.

A total of 8479 patients were included in the analysis. Of these patients, 712 were placed in CI postoperatively. After propensity matching, 596 patients (n = 298 CI, n = 298 non-CI) were matched. CI patients had significantly higher rates of operative mortality (13% (41/298) versus 2.3% (7/298), P < 0.001), readmission (29.8% (81/298) versus 11.8% (45/298), P < 0.001), postoperative deep vein thrombosis (8% (24/298) versus 0.6% (2/298), P < 0.001), postoperative pulmonary embolism (1.6% (5/298) versus 0% (0/298), P < 0.001), and failure to rescue 2.4% (12/298) versus 0.41% (2/298), P < 0.001).

Patient isolation may result in a reduction in direct patient care, to the detriment of patient outcomes.