The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different
The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different
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DOI：
10.1067/mtc.2002.122306
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发表时间：
2002-07-01
影响因子：
6
通讯作者：
Fraser, VJ
中科院分区：
文献类型：
--
作者：
Olsen, MA;Lock-Buckley, P;Fraser, VJ
目的：我们试图确定深，浅胸部伤口感染的危险因素，冠状动脉旁路移植术后，开发predictive models.Methods：我们回顾性分析了1980年1月1日，1996年6月30日，1999年，在我们的机构接受冠状动脉旁路移植术的连续患者收集的数据，通过使用社会的胸外科数据库。结果：胸部深部感染37例（1.9%），胸部浅部感染46例（2.3%）。肥胖糖尿病患者在控制主动脉内球囊反搏使用（比值比，3.1）和术后输血（比值比，2.3）后，胸部深部感染的风险增加了7.7倍。浅表性尿道感染的独立危险因素包括肥胖（比值比，3.1）、65岁或以上人群的糖尿病（比值比，2.7）和当前吸烟（比值比，2.5）。使用抗血小板药物与浅表感染风险降低相关（比值比，0.4）。预测手术死亡率作为疾病严重程度的标志，并不能明确预测深部或浅表器官部位感染。与未感染的对照组相比，胸部深部感染患者术后一年的死亡率增加（8/37 [21.6%] vs 114/1612 [7.1%]，P = 0.004），但在浅表性胸部感染患者中未发现（7/47 [15.2%] vs 114/1612 [7.1%]，P = 0.075）结论：冠状动脉旁路移植术后胸深、浅血管部位感染的危险因素不同，提示不同的发病机制。必须开发针对这些重要结果的适当风险分层模型。
Objective: We sought to determine risk factors for deep and superficial chest wound infections after coronary artery bypass graft surgery to develop predictive models.Methods: We retrospectively analyzed data collected on 1980 consecutive patients undergoing coronary artery bypass surgery at our institution between January 1, 1996, and June 30, 1999, by using the Society of Thoracic Surgery database. Independent risk factors for surgical-site infection were identified with multivariate logistic regression.Results: There were 37 (1.9%) deep chest and 46 (2.3%) superficial chest suroicalsite infections. Obese diabetic patients had a 7.7-fold increased risk of deep chest infections after controlling, for intra-aortic balloon pump use (odds ratio, 3.1) and postoperative transfusion (odds ratio, 2.3). Independent risk factors for Superficial surgical-site infections included obesity (odds ratio, 3.1), diabetes in persons 65 years of age or older (odds ratio, 2.7), and current smoking (odds ratio, 2.5). Use of antiplatelet drugs was associated with a lower risk Of Superficial infections (odds ratio, 0.4). Predicted operative mortality as a marker of severity of illness was not clearly predictive of deep or superficial surgical-site infection. Mortality in the year after the operation was increased in patients with deep chest infections compared with that seen in uninfected control subjects (8/37 [21.6%] vs 114/1612 [7.1%], P =.004) but not in patients with superficial chest infections (7/47 [15.2%] vs 114/1612 [7.1%], P =.075).Conclusions: Risk factors for deep and Superficial chest surgical-site infections after coronary artery bypass surgery differ, suggesting different mechanisms of pathogenesis. Appropriate risk stratification models specific to these important outcomes must be developed.