The association of intraoperative and early postoperative events with risk of pneumonia following cardiac surgery.
The association of intraoperative and early postoperative events with risk of pneumonia following cardiac surgery.
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术中和术后早期事件与心脏手术后肺炎风险的关联。
DOI：
10.1016/j.jtcvs.2023.09.056
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
MichiganSocietyofThoracicandCardiovascularSurgeonsQualityCollaborative
中科院分区：
文献类型：
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作者：
Barnett,NoahM;Liesman,DanielR;Strobel,RaymondJ;Wu,Xiaoting;Paone,Gaetano;DeLucia3rd,Alphonse;Zhang,Min;Ling,Carol;Pagani,FrancisD;Likosky,DonaldS;MichiganSocietyofThoracicandCardiovascularSurgeonsQualityCollaborative
肺炎是心脏手术后最常见的感染，与严重的发病率和死亡率有关。虽然先前的工作已经确定了术前肺炎的危险因素，但本研究评估术中和术后危险因素对心脏手术后肺炎的作用和相关影响。方法这项观察性队列研究评估了2011年至2021年期间33家机构接受冠状动脉和/或主动脉瓣手术的71,165名患者。比较了经验证的术前模型(模型一)和考虑了重要的术中(如搭桥时间)和术后(如拔管时间)因素的模型(模型二)的肺炎风险。结果术后肺炎发生率为2.62%。共有9个重要的术中和术后早期危险因素被识别。肺炎的绝对风险在模型1中增加：低(≤1.04%)、中(1.04%-2.40%)和高(>；2.40%)。模型二表现较好(c-统计量=0.771)。大多数患者(60.1%)术前与术中/术后的风险指标没有变化。合并模式二的患者中，19.6%的患者发生肺炎的风险增加，占所有肺炎事件的18.6%。结论本研究确定了9个重要的围手术期肺炎危险因素。根据术中和术后病程，几乎每5名患者中就有1名进入肺炎风险较高的类别。这些发现可以作为未来质量改进努力的重点，以降低患者术后肺炎的风险。
BackgroundPneumonia, the most common infection following cardiac surgery, is associated with major morbidity and mortality. Although prior work has identified preoperative risk factors for pneumonia, the present study evaluated the role and associated impact of intraoperative and postoperative risk factors on pneumonia after cardiac surgery.MethodsThis observational cohort study evaluated 71,165 patients undergoing coronary and/or aortic valve surgery across 33 institutions between 2011 and 2021. Terciles of estimated pneumonia risk were compared between a validated preoperative model (Model One) and a model additionally accounting for significant intraoperative (eg, bypass duration) and postoperative (eg, extubation time) factors (Model Two). Logistic regression was used to develop and validate Model Two.ResultsPostoperative pneumonia occurred in 2.62% of the patients. A total of 9 significant intraoperative and early postoperative risk factors were identified. The absolute risk of pneumonia increased across Model One terciles: low (≤1.04%), medium (1.04%-2.40%), and high (>2.40%). Model two performed well (c-statistic = 0.771). Most patients (60.1%) had no change in their preoperative versus intraoperative/postoperative risk tercile. The 19.6% of patients who increased their risk tercile with Model Two accounted for 18.6% of all pneumonia events.ConclusionsThis study identified 9 significant perioperative risk factors for pneumonia. Nearly 1 of every 5 patients moved into a higher pneumonia risk category based on their intraoperative and postoperative course. These findings may serve as the focus of future quality improvement efforts to reduce a patient's risk of postoperative pneumonia.