Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Anesthesiology, First Affiliated Hospital, Nangchang University, Nanchang City, Jiangxi Province, China.
J Cardiothorac Vasc Anesth. 2019 Jun;33(6):1610-1616. doi: 10.1053/j.jvca.2018.09.008. Epub 2018 Sep 8.
Surgery-related infection remains a major complication for patients undergoing cardiac surgery, and its association with thrombosis is unclear. This study aimed to examine the association of postoperative infection with thrombosis and major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing coronary artery bypass grafting (CABG).
Retrospective cohort study. Multiple variable regression analyses were performed.
The study was performed at a single institution.
All patients underwent CABG.
None.
Perioperative and postoperative follow-up data relating to all CABG patients from January 2001 to August 2006 were queried from institutional electronic medical records of Fuwai Hospital, Beijing, China. Patients were divided into 2 groups according to whether they experienced infection. The study population comprised 75 patients who experienced infection and 2,926 control patients. Primary outcomes were a composite outcome of perioperative thrombosis and long-term thrombosis-related complications. Secondary outcomes were 5-year MACCEs postoperatively, including death, myocardial infarction, target vessel revascularization, and stroke. Risk factors for infection included older age, higher level of creatinine, chronic lung disease, cardiopulmonary bypass time, aortic cross-clamp time, history of renal failure, cardiopulmonary bypass, left ventricular assist device or intra-aortic balloon pump, length of stay in the intensive care unit, and duration of tracheal intubation. Infection increased the odds of perioperative thrombosis by 5.132-fold (95% confidence interval [CI] 2.040-12.911; p < 0.0001) compared with control. However, infection was not associated with a significant increase in MACCEs (hazard ratio 1.855, 95% CI 0.929-3.704; p = 0.080). Age was associated with a significant increase in MACCEs (hazard ratio 1.040, 95% CI 1.026-1.054; p < 0.0001).
There is an association between postoperative infection and perioperative thrombosis after CABG. Several specific management modalities were associated with controlling infection risk, which offers targets for future quality improvement.
手术相关感染仍然是心脏手术患者的主要并发症，其与血栓形成的关系尚不清楚。本研究旨在探讨冠状动脉旁路移植术（CABG）后感染与血栓形成和主要不良心血管和脑事件（MACCE）的关系。
回顾性队列研究。进行了多变量回归分析。
该研究在一家机构进行。
所有接受 CABG 的患者。
无。
从中国北京阜外医院的机构电子病历中查询了 2001 年 1 月至 2006 年 8 月期间所有 CABG 患者的围手术期和术后随访数据。根据是否发生感染，患者被分为两组。研究人群包括 75 名发生感染的患者和 2926 名对照患者。主要结局是围手术期血栓形成和长期血栓形成相关并发症的复合结局。次要结局是术后 5 年的 MACCEs，包括死亡、心肌梗死、靶血管血运重建和中风。感染的危险因素包括年龄较大、肌酐水平较高、慢性肺部疾病、体外循环时间、主动脉阻断时间、肾衰竭史、体外循环、左心室辅助装置或主动脉内球囊泵、重症监护病房住院时间和气管插管时间。与对照组相比，感染使围手术期血栓形成的几率增加了 5.132 倍（95%置信区间[CI]为 2.040-12.911；p<0.0001）。然而，感染与 MACCEs 的显著增加无关（风险比 1.855，95%CI 0.929-3.704；p=0.080）。年龄与 MACCEs 的显著增加相关（风险比 1.040，95%CI 1.026-1.054；p<0.0001）。
CABG 后术后感染与围手术期血栓形成有关。一些特定的管理方式与控制感染风险有关，这为未来的质量改进提供了目标。
