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Author Notes:

Corresponding author: Annetine C. Gelijns, Ph.D., Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1077, New York, NY 10029, (1) 212 659 9567, annetine.gelijns@mssm.edu

Dr. Gillinov reports personal fees from Edwards Lifesciences, personal fees from Medtronic, personal fees from On-X, grants and personal fees from St. Jude Medical, personal fees from Abbott, personal fees and other from AtriCure, personal fees from ClearFlow, outside the submitted work.

Dr. Alexander reports grants from National Institutes of Health/NHLBI, during the conduct of the study.

Dr. Smith reports grants from NIH/CTSN , during the conduct of the study; personal fees from Abbott Vascular, personal fees from Edwards Lifesciences, grants from Edwards Lifesciences, personal fees from St Jude , outside the submitted work.

All other authors have no conflicts of interest to disclose.

The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; National Institutes of Health; or the United States Department of Health and Human Services.

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Research Funding:

A cooperative agreement (U01 HL088942) funded by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke of the NIH and the Canadian Institutes of Health Research.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Respiratory System
  • Surgery
  • Cardiovascular System & Cardiology
  • pneumonia
  • infections
  • cardiac surgery
  • outcomes
  • quality improvement
  • VENTILATOR-ASSOCIATED PNEUMONIA
  • CARE-ASSOCIATED INFECTIONS
  • RISK-FACTORS
  • IMPACT
  • TRANSFUSION
  • DATABASE
  • OUTCOMES
  • SOCIETY
  • QUALITY
  • MODELS

Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

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Journal Title:

Journal of Thoracic and Cardiovascular Surgery

Volume:

Volume 153, Number 6

Publisher:

, Pages 1384-U1171

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Rationale: Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. Objectives To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes. Methods A total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model. Measurements and Main Results The cumulative incidence of pneumonia was 2.4%, 33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95% CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95% CI, 10.31-16.58). Conclusions Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.

Copyright information:

© 2017 The American Association for Thoracic Surgery

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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