Nazer Rakan I, Alburikan Khalid A, Ullah Anhar, Albarrati Ali M, Hassanain Mazen
1 Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
2 Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Asian Cardiovasc Thorac Ann. 2018 Jul;26(6):439-445. doi: 10.1177/0218492318793305. Epub 2018 Aug 28.
Background Surgical site infections can have a significant impact on cardiac surgical outcome. The liver plays an important role in infection prevention. This study aimed to retrospectively determine whether transient postoperative liver dysfunction after coronary bypass surgery increased surgical site infections. Methods A modified version of the Schindl scoring scale for liver dysfunction was adapted to objectively quantify transient liver dysfunction in the first 7 days after on-pump coronary artery bypass grafting. A retrospective analysis of clinical outcomes at 30 months postoperatively was performed on data of 575 patients who underwent coronary artery bypass between 2014 and 2016. The patients were categorized into a liver dysfunction group (Schindl score ≥ 4) and a non-liver dysfunction group (Schindl score < 4). Results The liver dysfunction group (47.3%) had significantly more patients who were obese, current smokers, and had diabetes, renal impairment, and peripheral vascular disease. Surgical site infections occurred predominantly in the liver dysfunction group (12.1% vs. 0.3%, p < 0.001). The independent predictors of surgical site infection were liver dysfunction, body mass index > 30 kg m, and coronary bypass surgery combined with other cardiac procedures. Conclusions Surgical wound infections can be precipitated by multiple factors before, during, and after coronary bypass surgery. Transient liver dysfunction in the perioperative period is associated with an increased rate of surgical infections even after adjusting for known risk factors. Considering this factor as well as other known risks may help to identify and stratify patients with a potentially higher risk of surgical site infections.
背景 手术部位感染会对心脏手术的结果产生重大影响。肝脏在预防感染方面发挥着重要作用。本研究旨在回顾性确定冠状动脉搭桥手术后短暂性肝功能障碍是否会增加手术部位感染。方法 采用改良版的Schindl肝功能障碍评分量表，客观量化体外循环冠状动脉搭桥术后前7天的短暂性肝功能障碍。对2014年至2016年间接受冠状动脉搭桥手术的575例患者的数据进行术后30个月临床结局的回顾性分析。将患者分为肝功能障碍组（Schindl评分≥4）和非肝功能障碍组（Schindl评分<4）。结果 肝功能障碍组（47.3%）中肥胖、当前吸烟者以及患有糖尿病、肾功能损害和外周血管疾病的患者明显更多。手术部位感染主要发生在肝功能障碍组（12.1%对0.3%，p<0.001）。手术部位感染的独立预测因素为肝功能障碍、体重指数>30 kg/m²以及冠状动脉搭桥手术联合其他心脏手术。结论 冠状动脉搭桥手术前、手术中和手术后的多种因素均可引发手术伤口感染。即使在调整已知危险因素后，围手术期短暂性肝功能障碍仍与手术感染率增加相关。考虑这一因素以及其他已知风险可能有助于识别和分层具有潜在较高手术部位感染风险的患者。
