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Pneumonia raised risk for mortality, longer hospitalization in cardiac surgery patients
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Society of Thoracic Surgeons 48th Annual Meeting
Developing pneumonia after cardiac surgery was associated with a ninefold increased risk for death and a twofold increased risk for additional hospitalization, data presented at The Society of Thoracic Surgeons 48th Annual Meeting suggest.
Researchers found that among 5,184 cardiac surgery patients (mean age, 64.4 years; 33% women), pneumonia was the most common major infection and occurred in 2.4% (n=123) of patients after their procedures. Overall, isolated CABG (31%; n=1,597) and isolated valve (30%; n=1,549) were the two most common procedures. Median bypass time was 105 minutes and median time to extubation was 0.62 days.
Researchers assessed the independent association of baseline characteristics and management practices on the development of pneumonia within 60 ± 5 days of surgery, time to infection, length of hospital stay and mortality using multivariable logistic regression and Cox modeling. Patients experienced a mean time of 14.3 days and a median time of 8 days to development of pneumonia. Sixty-eight percent of events occurred during index hospitalization, according to study results. After adjusting for infection risk, the risk for death was 9.4 times higher and risk for an additional day of hospitalization was 2.4 times higher for patients who developed pneumonia after cardiac surgery.
Study results showed various processes of care affected pneumonia after adjusting for baseline risk. Receiving post-operation antibiotics within 48 hours, for instance, decreased risk for infection. The researchers said the identification of these practices should guide national improvement initiatives.
For more information:
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Ailawadi G. Pneumonia after cardiac surgery: Experience of the NIH/CIHR Cardiothoracic Surgical Trials Network. Presented at: The Society of Thoracic Surgeons 48th Annual Meeting; Jan. 29-Feb.1, 2012; Fort Lauderdale, Fla.
Disclosure: The researchers report no relevant financial disclosures.
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It's not a great surprise that if a patient has had cardiac surgery followed by pneumonia that it increases the risk for dying and certainly risk for longer hospitalization. These generally are older patients and they frequently have other risk factors that predispose them to developing pneumonia. Many have risk factors for CVD which would include advancing age, obesity and diabetes. Even if that information is controlled for, it's not a surprise that some of these patients would have developed pneumonia postoperatively. I have always been enormously impressed that the rate of that kind of complication after cardiac surgery is so low. I think that that is a testament to the excellent postoperative care that I have found in my clinical practice that patients who get cardiac surgery receive.
– William Schaffner, MD
President, National
Foundation for Infectious Diseases
Department of Preventive Medicine
Vanderbilt University Medical Center
Disclosure: Dr. Schaffner reports no relevant financial disclosures.
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