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Association Between Intraoperative Hyperlactatemia and Infection After Cardiac Surgery With Cardiopulmonary Bypass: A

Yewei Shi1,2, Yusu Wang2, Jielei Pan2

  • 1Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.

World Journal of Surgery
|February 13, 2026
PubMed

Insights

Intraoperative hyperlactatemia, or high blood lactate during surgery, independently increases the risk of postoperative infection in cardiac surgery patients. Maintaining lactate below 2.7 mmol/L may reduce infection risk.

Area of Science:

  • Cardiology
  • Surgical Infection Prevention
  • Critical Care Medicine

Background:

  • Postoperative infections are a significant concern in cardiac surgery.
  • Cardiopulmonary bypass (CPB) is associated with physiological changes that may impact infection risk.
  • Intraoperative lactate levels are a potential marker for tissue hypoperfusion and adverse outcomes.

Purpose of the Study:

  • To determine if intraoperative hyperlactatemia is an independent predictor of postoperative infection risk.
  • To identify the threshold of intraoperative blood lactate levels associated with increased infection risk in cardiac surgery patients undergoing CPB.

Main Methods:

  • A retrospective study of 4970 cardiac surgery patients who underwent CPB.
  • Intraoperative hyperlactatemia defined as blood lactate > 2.0 mmol/L.
  • Statistical analysis to assess the association between hyperlactatemia and postoperative infections, adjusting for confounders.

Main Results:

  • Postoperative infection occurred in 14.49% of patients.
  • Patients with infection had significantly higher intraoperative peak lactate levels (3.5 vs. 2.6 mmol/L).
  • Intraoperative hyperlactatemia was independently associated with a 1.49-fold increased risk of postoperative infection (aOR: 1.49; 95% CI: 1.18-1.91).
  • A peak lactate threshold of approximately 2.7 mmol/L was linked to higher infection risk.

Conclusions:

  • Intraoperative hyperlactatemia is an independent risk factor for postoperative infection in cardiac surgery with CPB.
  • Targeting intraoperative blood lactate levels below 2.7 mmol/L may be a strategy to reduce postoperative infection rates.
Abstract

Keywords:
cardiac surgerycardiopulmonary bypasshyperlactatemiainfectionlactateretrospective study

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