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BACKGROUND: At some point in their lives, many people will require major heart surgery (MHS). Patients are generally older adults with various risk factors for infection. However, the incidence of infection after MHS is poorly known, as reported infection data are frequently biased due to different factors like the surgical procedure, postoperative timing, and infectious syndromes or etiologic agents, among others. In addition, most patient data are retrospectively obtained. PURPOSE AND METHODS: Data were prospectively collected regarding the incidence of all nosocomial infections produced from the time of surgery to hospital discharge in a cohort of 800 adults consecutively undergoing a MHS procedure. RESULTS: During postoperative hospitalization, 124 of the 800 participants developed one or more infections (15.5%): during their ICU stay in 68 patients (54.8%), during their stay on the general ward post ICU in 50 (40.3%), and during their stay in both wards in 6 (4.8%). The most common infections were pneumonia (related or not to mechanical ventilation), surgical site and bloodstream. As etiological agents, 193 pathogens were isolated: mostly Gram-negative bacilli (54.4%), followed by Gram-positive bacteria (30%), viruses (4.6%) and fungi (1.5%). In our cohort, all-cause mortality was recorded in 33 participants (4.1%) and 9 infection-related deaths (1.1%) were produced. Among subjects who developed infections, overall mortality was 13.7% and in those who did not, this was only 2.3%. CONCLUSION: Infection following MHS remains frequent and severe. Our data suggest that hospital-acquired infection studies should consider episodes of infection in all populations during their entire hospital stay and not only those related to specific clinical syndromes or acquired while the patient is in intensive care.
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Procedimentos Cirúrgicos Cardíacos , Infecção Hospitalar , Humanos , Idoso , Alta do Paciente , Estudos Retrospectivos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Coração , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , HospitaisRESUMO
OBJECTIVES: Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG. METHODS: The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE. RESULTS: Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05-1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10-2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12-3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87-1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE. CONCLUSIONS: In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM.
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Idoso de 80 Anos ou mais , Idoso , Feminino , Humanos , Masculino , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Próteses Valvulares Cardíacas , Falha de Tratamento , Reoperação/métodos , Falha de PróteseRESUMO
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Humanos , Feminino , Idoso , Insuficiência da Valva Tricúspide/etiologia , Vasos Coronários/lesões , Cateterismo/efeitos adversos , Insuficiência da Valva Mitral/complicações , Doenças Reumáticas/complicaçõesRESUMO
Dada la infrautilización de los tratamientos de prevención secundaria en pacientes sometidos a cirugía cardiaca, se diseñó una intervención hospitalaria para mejorar su empleo consistente en el compromiso de los miembros del servicio de cirugía cardiaca de cumplimentar antes del alta hospitalaria un formulario que recordaba las indicaciones de los tratamientos recomendados, preguntaba por su prescripción, la dosis empleada, la causa de no prescribir, si era el caso, y el uso de fármacos alternativos. Su eficacia se evaluó comparando la tasa de utilización de los fármacos el año de su uso, 2003 (n = 341), con la del año previo, obtenida retrospectivamente (n =369). El uso de ácido acetilsalicílico, estatinas, inhibidoresde la convertasa angiotensínica y bloqueadores betaen candidatos ideales aumentó en total el 13,4, el 38,3, el 21,8 y el 21,5% respectivamente. En conclusión, una intervención sencilla y barata fue capaz de mejorar significativamente el empleo de fármacos de prevención secundaria en pacientes sometidos a cirugía cardiaca
Given that treatment for secondary prevention inpatients undergoing cardiac surgery is underused, wedevised a hospital intervention to increase itsimplementation. The intervention involved all physiciansin the department of cardiac surgery agreeing to completea report on each patient before hospital discharge. Thedocument recorded the indications for the recommendedtreatments, and prompted for details of the drugsprescribed, the doses used, the reasons for notprescribing the recommended drugs, if that was the case,and the use of alternative medicines. The efficacy of theintervention was evaluated by comparing the rate of druguse in the year in which it was introduced (2003, n=341)with retrospective data on the rate in the previous year(n=369). The rates of use of aspirin, statins, angiotensinconverting enzyme inhibitors, and beta-blockers by patients who required them all showed an absolute increase, of 13.4%, 38.3%, 21.8%, and 21.5%,respectively. In conclusion, the introduction of a simpleand inexpensive intervention was able to significantlyincrease the use of drugs for secondary prevention inpatients undergoing cardiac surgerya