Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Eur Surg Res. 2022;63(2):55-63. doi: 10.1159/000518403. Epub 2021 Sep 16.
The present study aimed to identify significant causes of readmission within 30 days following coronary artery bypass graft (CABG) surgery and compare readmission incidence related to surgical site infections (SSIs) before and after implementing international recommendations for antibiotic prophylaxis.
We analyzed 2,225 CABG patients who received either guideline-directed antibiotic prophylaxis (GDAP = 568) or institutional antibiotic prophylaxis (non-GDAP = 1,657) between January 2017 and December 2019. The primary outcome was a composite of sternal wound infection (SWI) or harvest SWI. Secondary outcomes consisted of the individual components of composite end point, the incidence of in-hospital SSIs, and prolonged postoperative length of hospital stay (LOS) (>7 days). Propensity matching was used to select pairs for final comparison.
Before implementing GDAP, the most frequent reason for readmission were SSIs, causing 58.2% of all readmissions within 30 days. Of 429 matched pairs, 48 patients in the GDAP group and 67 patients in the non-GDAP group were readmitted to a hospital within 30 days for any cause (11.2 vs. 15.6%, p = 0.048). We found a decreased readmission incidence for reasons related to SSIs, although these differences did not reach statistical significance (7.4 vs. 10.0%, p = 0.069). Adherence to GDAP was associated with reduced in-hospital risks of SSIs and prolonged postoperative LOS (19.6 vs. 26.6%, p = 0.015).
In this contemporary clinical practice study, the adherence to GDAP was an insufficient measure to decrease rehospitalization due to SSIs. The present findings warrant further investigation on factors that may contribute to SSIs development after hospital discharge.
本研究旨在确定冠状动脉旁路移植术（CABG）后 30 天内再次入院的主要原因，并比较实施抗生素预防国际建议前后与手术部位感染（SSI）相关的再入院发生率。
我们分析了 2017 年 1 月至 2019 年 12 月期间接受指南指导的抗生素预防（GDAP=568）或机构抗生素预防（非-GDAP=1657）的 2225 例 CABG 患者。主要结局是胸骨伤口感染（SWI）或采集 SWI 的复合结果。次要结局包括复合终点的各个组成部分、院内 SSI 的发生率以及术后住院时间延长（>7 天）。采用倾向匹配选择最终比较的配对。
在实施 GDAP 之前，导致 30 天内所有再入院的最常见原因是 SSI，占 58.2%。在 429 对匹配的患者中，GDAP 组和非-GDAP 组分别有 48 例和 67 例在 30 天内因任何原因再次住院（11.2%比 15.6%，p=0.048）。我们发现与 SSI 相关的再入院发生率降低，尽管这些差异没有达到统计学意义（7.4%比 10.0%，p=0.069）。遵守 GDAP 与降低院内 SSI 风险和延长术后住院时间相关（19.6%比 26.6%，p=0.015）。
在这项当代临床实践研究中，遵守 GDAP 是降低因 SSI 再次住院的一项不足够的措施。本研究结果表明需要进一步研究可能导致出院后 SSI 发展的因素。
