Analysis of Characteristics and Risk Factors of Surgical Site Infection after Coronary Artery Bypass Graft

Mi Hye Kim; Jae Sim Jeong; Sung Ho Choi

doi:10.14192/kjhaicp.2016.21.2.57

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Kim, Jeong, and Choi: Analysis of Characteristics and Risk Factors of Surgical Site Infection after Coronary Artery Bypass Graft

Original Article

Korean J Healthc Assoc Infect Control Prev 2016;21(2):57-64.

Published online: 19 December 2016

DOI: https://doi.org/10.14192/kjhaicp.2016.21.2.57

Analysis of Characteristics and Risk Factors of Surgical Site Infection after Coronary Artery Bypass Graft

Mi Hye Kim^1,², Jae Sim Jeong^2,³, Sung Ho Choi⁴

¹Department of Nursing, Asan Medical Center, Seoul, Korea

²Department of Clinical Nursing, University of Ulsan Graduate School of Industrial Technology, Ulsan, Korea

³Department of Nursing, University of Ulsan College of Medicine, Ulsan, Korea

⁴Department of Cardiacthoracic Surgery, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea

Correspondence to: Jae Sim Jeong, Department of Nursing, University of Ulsan College of Medicine, Daehak-ro, Nam-gu, Ulsan 44610, Korea Tel: 052-259-1298, Fax: 052-259-1236 E-mail: jsejongicp@ulsan.ac.kr

Received 19 October 2016 Accepted 5 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The purpose of this study was to examine surgical site infection (SSI) characteristics and risk factors in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods

A retrospective observational study was conducted, involving patients undergoing CABG surgery at a tertiary care hospital in Seoul, between January 2010 and December 2013. This study adopted the SSI definition proposed by the Centers for Disease Control and Prevention and only infections at the sternotomy site were included. Multivariate risk analysis was performed to identify independent risk factors for CABG SSI.

Results

Out of 998 CABG patients, 3.9% (39) cases of SSI were identified. In multivariate analysis, diabetes mellitus (OR=2.016, 95% CI=0.994-4.089), increased body mass index (BMI) (OR=4.555, 95% CI=1.748-11.871), red blood cell (RBC) transfusion (OR=1.106, 95% CI=1.021-1.197), and undergoing cardio-pulmonary bypass surgery (OR=2.790, 95% CI=1.239-6.286) were significantly associated with CABG SSI.

Conclusion

Diabetes mellitus, increased BMI, RBC transfusion, and undergoing cardio-pulmonary bypass surgery are independent risk factors for CABG SSI.

Keywords: Coronary artery bypass, Risk factors, Surgical wound infection

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Table 1.

Characteristics of surgical site infections after coronary artery bypass graft

Characteristics	N (%)
Type of surgical site infection
Superficial	4 (10.3)
Deep incisional	9 (23.1)
Mediastinitis	26 (66.7)
Duration from operation to SSI (day)
≤5	1 (2.6)
6-10	4 (10.3)
11-20	10 (25.6)
21-30	14 (35.9)
31-60	8 (20.5)
≥60^*	2 (5.1)
Mean±SD (median)	31.0±43.9 (23)
Causative organisms
Coagulase negative staphylococci	22 (56.4)
Methicillin-resistant Staphylococcus. aureus	7 (18.0)
Acinetobacter baumannii	4 (10.3)
Candida albicans	3 (7.7)
Corynebacterium spp.	2 (5.1)
Enterococcus faecalis	1 (2.6)

^* The duration of two surgical site infection cases were 75 and 285 days.

Table 2.

Univariate analysis of risk factors associated with surgical site infection (SSI)

Variables		Total	N (%), Mean±SD		P-value	Odds ratio	95% CI
Variables		Total	SSI (n=39)	No SSI (n=959)	P-value	Odds ratio	95% CI
Gender
	Male	766 (76.8)	31 (79.5)	735 (96.0)		1
	Female	232 (23.2)	8 (20.5)	224 (23.4)	.680	0.847	0.384-1.869
Age (years)		64.2±9.2	65.8±9.7	64.2±9.2	.275	1.020	0.984-1.058
Current smoking
	No	446 (44.7)	12 (30.8)	434 (45.3)		1
	Yes	552 (55.3)	27 (69.2)	525 (54.7)	0.079	1.860	0.931-3.715
Diabetes mellitus
	No	530 (53.1)	13 (33.3)	517 (53.9)		1
	Yes	468 (46.9)	26 (66.7)	442 (46.1)	.014	2.339	1.188-4.607
Alcohol drinking
	No	561 (56.2)	22 (56.4)	539 (56.2)		1
	Yes	437 (43.8)	17 (43.6)	420 (43.8)	.980	1.008	0.529-1.923
Hypertension
	No	384 (38.5)	15 (38.5)	369 (38.5)		1
	Yes	614 (61.5)	24 (61.5)	590 (61.5)	.998	0.999	0.517-1.930
Body Mass Index
	≤24.9	603 (60.4)	20 (51.3)	583 (60.8)		1
	25.0-29.9	348 (38.5)	13 (33.3)	335 (34.9)	.734	1.131	0.556-2.303
	≥30.0	47 (4.7)	6 (15.4)	41 (4.3)	.003	4.266	1.624-11.205
ASA class score
	1	5 (0.5)	1 (2.5)	4 (0.4)		1
	2	323 (32.4)	9 (23.1)	314 (32.7)	.077	0.127	0.013-1.245
	3	624 (62.5)	26 (66.7)	598 (62.4)	.116	0.167	0.018-1.551
	4	46 (4.6)	3 (7.7)	43 (4.5)	.314	0.279	0.023-3.347
Total bilirubin (preoperative) (mg/dl)
	≤0.2	31 (3.1)	1 (2.6)	30 (3.1)		1
	0.2-1.2	915 (91.7)	36 (92.3)	879 (91.7)	.842	1.229	0.163-9.263
	≥1.3	52 (5.2)	2 (5.1)	50 (5.2)	.884	1.200	0.104-13.806
White blood cell (preoperative) (×10³/μl)
	＜5.0	152 (15.2)	4 (10.3)	148 (15.4)		1
	5.0-10.0	773 (77.5)	29 (74.3)	744 (77.6)	.498	1.442	0.500-4.163
	≥10.0	73 (7.3)	6 (15.4)	67 (7.0)	.070	3.313	0.905-12.129
Preoperative length of stay (day)		6.2±7.2	6.3±4.8	6.1±7.3	.822	1.004	0.968-1.042
Duration of operation (min)		241.5±61.5	237.9±73.0	241.5±61.0	.713	0.999	0.994-1.004
Emergency operation
	No	935 (93.7)	38 (97.4)	897 (93.5)		1
	Yes	63 (6.3)	1 (2.6)	62 (6.5)	.345	2.627	0.355-19.450
IMA (internal mammary artery)
	No	18 (1.8)	0.0	18 (2.0)		1
	Single	916 (91.8)	34 (87.1)	882 (91.8)	.291	1.684	0.640-4.431
	Bilateral	64 (6.4)	5 (12.9)	59 (6.2)	.104	0.446	0.168-1.182
CPB (cardio-pulmonary bypass)
	No	959 (96.0)	30 (77.0)	929 (76.9)		1
	Yes	39 (3.9)	9 (23.0)	30 (3.1)	.007	2.933	1.349-6.373
Postoperative bleeding control
	No	943 (94.5)	36 (92.3)	907 (94.6)		1
	Yes	55 (5.5)	3 (7.7)	52 (5.4)	.545	1.461	0.205-2.308
RBC transfusion in operating room (pint)
	No	456 (45.7)	14 (35.9)	442 (46.1)		1
	1-2	350 (35.0)	13 (33.3)	337 (35.1)	.615	1.218	0.565-2.625
	3-4	160 (16.0)	9 (23.1)	151 (15.7)	.148	1.882	0.798-4.436
	≥5	32 (3.2)	3 (7.7)	29 (3.0)	.075	3.266	0.888-12.012
RBC transfusion in ICU (pint)
	No	511 (51.2)	150 (38.5)	361 (37.6)		1
	1-2	471 (47.2)	17 (43.6)	454 (47.3)	.901	0.436	0.138-1.376
	3-4	105 (10.5)	3 (7.7)	102 (10.6)	.591	0.393	0.126-1.222
	＞5	46 (4.6)	4 (10.3)	42 (4.4)	.157	0.309	0.066-1.440
Total transfusion amount (pint)		2.7±3.5	2.7±1.1	2.4±0.9	.008	1.109	1.027-1.198

Abbreviations: CI, confidence interval; ASA, American Society of Anesthesiologist; RBC, red blood cell; ICU, intensive care unit.

Table 3.

Multivariate analysis of risk factors for surgical site infections after coronary artery bypass graft

Variables	P-value	Odds ratio	95% CI
Current smoking	0.052	2.016	0.994-4.089
Diabetes mellitus	0.037	2.080	1.043-4.145
Body Mass Index =30 kg/m^*	0.002	4.555	1.748-11.871
RBC transfusion amount^†	0.013	1.106	1.021-1.197
Use of cardio-pulmonary bypass	0.013	2.790	1.239-6.286

^* Reference ＜30 kg/m;

^† By 1 unit increments.

Abbreviation: CI, confidence interval.

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