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Poeran J, Mazumdar M, Rasul R, Meyer J, Sacks HS, Koll BS, Wallach FR, Moskowitz A, Gelijns AC. Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2015; 151:589-97.e2. [PMID: 26545971 DOI: 10.1016/j.jtcvs.2015.09.090] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Antibiotic use, particularly type and duration, is a crucial modifiable risk factor for Clostridium difficile. Cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. We aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and C difficile among patients undergoing coronary artery bypass grafting. METHODS We extracted data on coronary artery bypass grafting procedures from the national Premier Perspective claims database (2006-2013, n = 154,200, 233 hospitals). Multilevel multivariable logistic regressions measured associations between (1) duration (<2 days, "standard" vs ≥2 days, "extended") and (2) type of antibiotic used ("cephalosporin," "cephalosporin + vancomycin," "vancomycin") and C difficile as outcome. RESULTS Overall C difficile prevalence was 0.21% (n = 329). Most patients (59.7%) received a cephalosporin only; in 33.1% vancomycin was added, whereas 7.2% received vancomycin only. Extended prophylaxis was used in 20.9%. In adjusted analyses, extended prophylaxis (vs standard) was associated with significantly increased C difficile risk (odds ratio, 1.43; confidence interval, 1.07-1.92), whereas no significant associations existed for vancomycin use as adjuvant or primary prophylactic compared with the use of cephalosporins (odds ratio, 1.21; confidence interval, 0.92-1.60, and odds ratio, 1.39; confidence interval, 0.94-2.05, respectively). Substantial inter-hospital variation exists in the percentage of extended antibiotic prophylaxis (interquartile range, 2.5-35.7), use of adjuvant vancomycin (interquartile range, 4.2-61.1), and vancomycin alone (interquartile range, 2.3-10.4). CONCLUSIONS Although extended use of antibiotic prophylaxis was associated with increased C difficile risk after coronary artery bypass grafting, vancomycin use was not. The observed hospital variation in antibiotic prophylaxis practices suggests great potential for efforts aimed at standardizing practices that subsequently could reduce C difficile risk.
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Affiliation(s)
- Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rehana Rasul
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joanne Meyer
- Department of Pharmacy, The Mount Sinai Hospital, New York, NY
| | - Henry S Sacks
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian S Koll
- Icahn School of Medicine at Mount Sinai, New York, NY; Infection Prevention and Control, Mount Sinai Health System, New York, NY
| | - Frances R Wallach
- Icahn School of Medicine at Mount Sinai, New York, NY; Infection Prevention and Control, Mount Sinai Health System, New York, NY
| | - Alan Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Novel Method of Infection Prophylaxis in Heart Transplantation by Retrosternal Gentamycin Sponge Application. Transplant Proc 2015; 47:1954-7. [PMID: 26293080 DOI: 10.1016/j.transproceed.2015.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/02/2015] [Accepted: 02/10/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical wound infections are more frequent in patients undergoing heart transplantation than in other heart surgery patients. There is a wide spread of sternal wound infection incidence in transplant patients ranging from 4% to 40%. It is first study describing local gentamicin sponge application during heart transplantation procedure. MATERIALS AND METHODS We enrolled 75 patients in a retrospective, single-center study, including 25 patients who underwent orthotopic heart transplantation (heart transplant group) and 50 in the cardiac surgery group. They were in mean age of 49 ± 12 years and 51 ± 13 years in heart transplantation and cardiac surgery group, respectively. A gentamicin sponge was inserted intraoperatively between sternal borders before chest closure in all heart transplantation patients. RESULTS There was 1 early death (4%) on postoperative day 7 owing to Clostridium difficile infection in the heart transplant group. There was 1 death (2%) in the cardiac surgery group owing to multiorgan failure secondary to perioperative heart ischemia. There was neither bacterial sternal wound infection nor sternal instability in the heart transplant group. None of the patients who had gentamicin sponge applied had wound healing problems. Two patients (4%) had a deep sternal wound infection in the cardiac surgery group, who had no sponge application; 1 (2%) was treated by surgical debridement and active drainage and 1 (2%) by vacuum therapy. There were 11 patients (44%) discharged on insulin therapy in the heart transplant group and 21 (21%) in the cardiac surgery group. Mean overall postoperative hospital stay was 35 ± 19 days in the heart transplant group and 10 ± 4 days in the cardiac surgery group. CONCLUSIONS Gentamicin sponge is an effective local infection prophylaxis in heart transplant patients.
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Robich MP, Sabik JF, Houghtaling PL, Kelava M, Gordon S, Blackstone EH, Koch CG. Prolonged Effect of Postoperative Infectious Complications on Survival After Cardiac Surgery. Ann Thorac Surg 2015; 99:1591-9. [DOI: 10.1016/j.athoracsur.2014.12.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/02/2014] [Accepted: 12/05/2014] [Indexed: 11/16/2022]
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Pitsiou G, Kioumis I, Zarogoulidis K, Lazaridis G, Papaiwannou A, Tsirgogianni K, Karavergou A, Lampaki S, Rapti A, Trakada G, Zissimopoulos A, Karaiskos T, Madesis A, Drosos G, Zarogoulidis P. Prophylactic antibiotic administration for post cardiothoracic surgery sternal wounds: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:56. [PMID: 25861611 DOI: 10.3978/j.issn.2305-5839.2015.03.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cardiothoracic surgery sternal infections are difficult to treat situations. Until now there are no clear guidelines which or if an antibiotic could be used as prophylactic treatment. PATIENTS AND METHODS We collected retrospectively data from 535 patients from our hospital which underwent cardiothoracic surgery and recorded several biological parameters and technical aspects of the surgery. RESULTS It was observed that patients to whom vancomycin was administered had less post surgery infection than those to whom begalin was administered. Male who were treated with vancomycin it was observed that they had 1.67 chances to be treated properly than female. Patients which were hospitalized for more than 7 days before surgery had 62.6% higher chances for post surgery infection. CONCLUSIONS It was observed that vancomycin can be used as a prophylactic treatment for cardiothoracic surgeries acting efficiently against sternal wounds.
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Affiliation(s)
- Georgia Pitsiou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Lazaridis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Papaiwannou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Tsirgogianni
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Karavergou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Lampaki
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Rapti
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Trakada
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Drosos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Trent Magruder J, Grimm JC, Dungan SP, Shah AS, Crow JR, Shoulders BR, Lester L, Barodka V. Continuous Intraoperative Cefazolin Infusion May Reduce Surgical Site Infections During Cardiac Surgical Procedures: A Propensity-Matched Analysis. J Cardiothorac Vasc Anesth 2015; 29:1582-7. [PMID: 26275516 DOI: 10.1053/j.jvca.2015.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The authors sought to determine whether an institutional transition from intermittent to continuous dosing of intraoperative antibiotics in cardiac surgery affected surgical site infection (SSI) outcomes. DESIGN A retrospective chart review utilizing propensity matching. SETTING A single academic, tertiary care hospital. PARTICIPANTS One thousand one hundred seventy-nine patients undergoing coronary artery bypass grafting (CABG) and/or cardiac valvular surgery between April 2013 and November 2014 who received perioperative cefazolin. INTERVENTIONS By method of cefazolin administration, patients were divided into an "intermittent-dosing" (ID) group and a "continuous-infusion" (CI) group. MEASUREMENTS AND MAIN RESULTS Of the 1,179 patients who underwent cardiac surgery during the study period, 1:1 propensity score matching yielded 399 patients in each group. Rates of diabetes (33.6% ID v 33.8% CI, p = 0.94), coronary artery bypass (62.3% v 61.4%, p = 0.66), and bilateral internal mammary artery harvesting (6.0% v 8.3%, p = 0.22) were similar between groups. SSIs occurred in more ID patients than CI patients (2.3% v 0.5%, p = 0.03). This difference was driven by decreases in extremity and conduit harvest site SSIs (1.8% v 0.3%, p = 0.03), as there were no episodes of mediastinitis, and superficial sternal SSI rates did not differ (0.5% v 0.3%, p = 0.56). There also were significantly fewer episodes of pneumonia in the CI group (6.0% v 2.3%, p = 0.008). Intensive care unit and total lengths of stay did not differ. Thirty-day mortality was 2.8% in both groups (p = 1.00). CONCLUSIONS As compared to ID regimens, CI cefazolin infusion may reduce post-cardiac surgery infectious complications. Further study in larger patient populations is needed.
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Affiliation(s)
| | | | | | | | | | - Bethany R Shoulders
- Cardiac Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laeben Lester
- Cardiac Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Viachaslau Barodka
- Cardiac Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Greco G, Shi W, Michler RE, Meltzer DO, Ailawadi G, Hohmann SF, Thourani VH, Argenziano M, Alexander JH, Sankovic K, Gupta L, Blackstone EH, Acker MA, Russo MJ, Lee A, Burks SG, Gelijns AC, Bagiella E, Moskowitz AJ, Gardner TJ. Costs associated with health care-associated infections in cardiac surgery. J Am Coll Cardiol 2015. [PMID: 25572505 DOI: 10.1016/j.jacc.201.09.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs. CONCLUSIONS Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).
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Affiliation(s)
- Giampaolo Greco
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
| | - Wei Shi
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Robert E Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Vinod H Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - John H Alexander
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kathy Sankovic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lopa Gupta
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Acker
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Albert Lee
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Sandra G Burks
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Timothy J Gardner
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
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107
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Greco G, Shi W, Michler RE, Meltzer DO, Ailawadi G, Hohmann SF, Thourani VH, Argenziano M, Alexander JH, Sankovic K, Gupta L, Blackstone EH, Acker MA, Russo MJ, Lee A, Burks SG, Gelijns AC, Bagiella E, Moskowitz AJ, Gardner TJ. Costs associated with health care-associated infections in cardiac surgery. J Am Coll Cardiol 2015; 65:15-23. [PMID: 25572505 DOI: 10.1016/j.jacc.2014.09.079] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs. CONCLUSIONS Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).
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Affiliation(s)
- Giampaolo Greco
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
| | - Wei Shi
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Robert E Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Vinod H Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - John H Alexander
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kathy Sankovic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lopa Gupta
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Acker
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Albert Lee
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Sandra G Burks
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Timothy J Gardner
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
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Marcassa C, Pistono M, Maserati R, Giordano A, Giannuzzi P. Disability after cardiac surgery is the major predictor of infections occurring in the rehabilitation phase. Eur J Prev Cardiol 2015; 23:584-92. [DOI: 10.1177/2047487315576129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/13/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Claudio Marcassa
- Cardiology Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (NO), Italy
- Bioengineering Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (NO), Italy
| | - Massimo Pistono
- Cardiology Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (NO), Italy
| | - Renato Maserati
- Department of Infectious Disease, San Matteo Hospital, IRCCS, Pavia, Italy
| | - Andrea Giordano
- Bioengineering Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (NO), Italy
| | - Pantaleo Giannuzzi
- Cardiology Department, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (NO), Italy
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109
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Badhwar V, Jacobs JP. Infections following cardiac surgery: an opportunity for clarity. J Am Coll Cardiol 2015; 65:24-26. [PMID: 25572506 DOI: 10.1016/j.jacc.2014.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Vinay Badhwar
- Division of Cardiac Surgery, Presbyterian University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Jeffrey P Jacobs
- Johns Hopkins University, All Children's Hospital, St. Petersburg, Florida
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110
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The reduction of post-cardiac surgery infections by statins: solid evidence? Neth Heart J 2014; 22:501-2. [PMID: 25273922 PMCID: PMC4391178 DOI: 10.1007/s12471-014-0605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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111
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Infections post-cardiac surgery: new information during challenging times. J Am Coll Cardiol 2014; 64:382-4. [PMID: 25060373 DOI: 10.1016/j.jacc.2014.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/20/2014] [Indexed: 11/21/2022]
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