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A fifteen-year wound surveillance study after coronary artery bypass
M S Slaughter1, M M Olson, J T Lee
1Department of Surgery, Minneapolis Veterans Affairs Medical Center, MN 55417.
Abstract:
Wound infections after coronary artery bypass operations have been continuously monitored at the Minneapolis Veterans Affairs Hospital for 15 years. All patients were followed up for 30 days. From 1977 to 1991, 2,402 coronary artery bypass operations were performed, and wound infections developed in 125 (5%) patients. There were 71 (3%) chest infections of which 33 (1.4%) were major and 38 (1.6%) superficial. Greater than 94% of these grew only a single organism, of which 74% were Staphylococcus species. There were 63 (2.6%) leg wound infections. More than 50% of these grew multiple organisms, of which 68% were enteric in origin. Nine (0.4%) patients had simultaneous chest and leg infections. Wound infections were diagnosed an average of 15.3 +/- 6.7 (range, 4 to 30) days postoperatively, with 50% occurring after discharge from the hospital. Of 14 variables evaluated by multivariate logistic regression analysis, only steroids (p = 0.005) and diabetes (p = 0.003) were identified as independent risk factors for wound infections. Patients taking steroids or with diabetes tended to have chest infections, whereas obese patients tended to have more leg infections (p = 0.08). During an interval in the surveillance program, a trend toward increasing infections was identified and successfully reversed.
Insights
Coronary artery bypass surgery patients experienced a 5% wound infection rate. Steroids and diabetes were key risk factors for chest infections, while obesity increased leg infection risk.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Epidemiology
- Hospital Quality Improvement
Background:
- Wound infections are a significant complication following coronary artery bypass operations.
- Continuous surveillance is crucial for monitoring and managing infection rates in surgical settings.
Purpose of the Study:
- To analyze the incidence and risk factors of wound infections after coronary artery bypass operations.
- To identify trends and implement interventions to reduce infection rates.
Main Methods:
- A 15-year surveillance study of 2,402 coronary artery bypass operations.
- Follow-up for 30 days post-surgery, including analysis of infection types, causative organisms, and patient variables.
- Multivariate logistic regression to identify independent risk factors.
Main Results:
- A 5% overall wound infection rate (125/2,402), with 3% chest infections and 2.6% leg infections.
- Staphylococcus species were the most common cause of chest infections; enteric organisms predominated in leg infections.
- Steroids (p=0.005) and diabetes (p=0.003) were independent risk factors for wound infections, particularly chest infections.
Conclusions:
- Steroid use and diabetes are significant independent risk factors for wound infections post-CABG.
- Obesity is associated with an increased risk of leg wound infections.
- Surveillance and targeted interventions can effectively reverse trends of increasing infection rates.