Program Schedule

1018
Risk Factors for Surgical Site Infection Following Cardiovascular Surgery

Session: Poster Abstract Session: Surgical Site Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDSA Poster_CVsurgSSI_1018.pdf (455.5 kB)
  • Background:

    Prior studies evaluating the risk of cardiovascular (CV) sternal incisional surgical site infection (SSI) have been small and have not evaluated for SSI risk factors using standard epidemiologic definitions. We sought to identify patient- and procedure-related risk factors for sternal incisional SSI following CV surgeries.

    Methods:

    All patients undergoing coronary artery bypass grafting (CABG) or valve replacement surgery Oct 2005-May 2013 were included. Data was aggregated from Society of Thoracic Surgeons and Hospital Epidemiology databases. SSIs were classified as superficial and deep or organ/space (D/OS) using National Healthcare Safety Network criteria. The primary outcome was SSI occurring within 90 days of surgery. Subgroup analyses were performed by procedure type and restricted to D/OS SSI outcomes. Modeling was performed using multivariate proportional hazards regression with stepwise selection.

    Results:

    114 (2.9%) of 3997 patients (717 undergoing both CABG and valve replacement) developed any SSI, including 53 (46.5 %) superficial SSIs and 61 (53.5 %) D/OS SSIs. Final multivariable models are presented in the Table.

    Risk Factors for SSI Among Patients Undergoing Cardiovascular Surgery

    All Subjects

    CABG

    Valve

    Deep / Organ Space

    # In Analysis Group

    3997

    3005

    1709

    3997

    # of SSIs (%)

    114 (2.9%)

    94 (3.1%)

    36 (2.1%)

    61 (1.5%)

    HR

    p- value

    HR

    p-value

    HR

    p-value

    HR

    p-value

    Female

    3.19

    <.0001

    3.90

    <.0001

    2.15

    0.0296

    3.11

    <.0001

    BMI

    Normal/ Underweight

    (<25)

    Ref

    Ref

    Ref

    Ref

    Overweight (25-30)

    1.86

    0.0709

    1.58

    0.2097

    3.96

    0.0800

    1.62

    0.2653

    Obese (>30)

    4.85

    <.0001

    3.45

    0.0002

    13.70

    0.0004

    1.62

    0.0005

    History of MRSA

    2.78

    0.0046

    -

    3.20

    0.0175

    2.42

    0.0455

    Peripheral Vascular Disease

    -

    1.66

    0.0425

    -

    2.20

    0.0089

    Hypertension

    -

    3.52

    0.0324

    -

    -

    ADP Inhibitor

    1.67

    0.0263

    -

    -

    -

    Fiscal Year

    2013

    0.51

    0.1338

    -

    -

    -

    2012

    0.34

    0.0251

    -

    -

    -

    2011

    0.50

    0.0692

    -

    -

    -

    2010

    0.55

    0.1236

    -

    -

    -

    2009

    1.15

    0.6749

    -

    -

    -

    2008

    1.13

    0.7152

    -

    -

    -

    2007

    0.91

    0.7852

    -

    -

    -

    2006

    Ref

    Case Type

    Elective

    Ref

    Urgent

    -

    -

    0.96

    0.9407

    -

    Emergent

    -

    -

    5.90

    0.0043

    -

    Variables not included in final model denoted by ( ).

    Conclusion:

    Female sex and obesity were robustly associated with increased hazard of SSI, including among surgery subgroups and when restricting to D/OS SSI outcome. Future prevention efforts should consider issues related to obesity, particularly among women, which may be related to tension across sternal incision.

    Graham Snyder, MD, SM1,2, David S. Yassa, MD1,2, Chloe W Eng, BS1, Linda M Baldini, RN1, Kamal Khabbaz, MD3 and Sharon B Wright, MD, MPH1,2, (1)Division of Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, MA, (2)Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, (3)Division of Cardiothoracic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA

    Disclosures:

    G. Snyder, None

    D. S. Yassa, None

    C. W. Eng, None

    L. M. Baldini, None

    K. Khabbaz, None

    S. B. Wright, None

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