低收入国家心脏手术后医院获得性感染和死亡率的预测因素：一项回顾性队列研究
Predictors of Postoperative Hospital-Acquired Infection and Mortality Following Cardiac Surgery in a Low-Income Country: A Retrospective Cohort Study.
作者信息
Fagundes Camila Sales, Chemello Diego, Marchesan Luana Quintana, Kohlrausch Vitória Carolina, Locateli Rafael Fortes, Santos Eduardo Porto, Brixner Isabella Klafke, Bayer Valéria Maria Limberger, Marques Mateus Diniz
机构信息
Department of Clinical Medicine, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.
出版信息
Braz J Cardiovasc Surg. 2025 Mar 27;40(2):e20240111. doi: 10.21470/1678-9741-2024-0111.
INTRODUCTION
Recognizing the risk factors for postoperative hospital-acquired infection and mortality is crucial for better outcomes. We aimed to determine the risk predictors for postoperative hospital-acquired infection and death following cardiac surgery.
METHODS
This is a retrospective cohort study that included 880 consecutive adult patients who underwent cardiac surgery between 2015 and 2021. Multivariable logistic regression was performed to assess the predictors of postoperative hospital-acquired infection and mortality.
RESULTS
Patients who developed postoperative hospital-acquired infection had higher values on European System for Cardiac Operative Risk Evaluation score (4.01% vs. 2.51%; P=0.001), as well as longer hospital preoperative stay (9.44 vs. 8.28 days; P=0.049) and hospital length of stay (28.41 vs. 16.16 days; P<0.001). After multivariable analysis, predictors of postoperative hospital-acquired infection were longer hospital preoperative stay (odds ratio 1.024; 95% confidence interval 1.005-1.044; P=0.009), higher body mass index (odds ratio 1.043; 95% confidence interval 1.008-1.079; P=0.015), and longer extracorporeal circulation time (odds ratio 1.007; 95% confidence interval 1.003-1.012; P<0.001). Both longer extracorporeal circulations time and postoperative hospital-acquired infection were significantly associated with higher mortality before hospital discharge (odds ratio 1.012; 95% confidence interval 1.006-1.019; P<0.001; and odds ratio 2.418; 95% confidence interval 1.385-4.233; P=0.001, respectively).
CONCLUSION
Extended preoperative hospitalization, body mass index, and extracorporeal circulation time are correlated with heightened postoperative hospital-acquired infection rates. Moreover, longer extracorporeal circulation time and postoperative hospital-acquired infection incidence emerged as significant predictors of mortality following cardiac surgery.
引言
识别术后医院获得性感染和死亡的风险因素对于获得更好的治疗结果至关重要。我们旨在确定心脏手术后医院获得性感染和死亡的风险预测因素。
方法
这是一项回顾性队列研究，纳入了2015年至2021年间连续接受心脏手术的880例成年患者。采用多变量逻辑回归分析来评估术后医院获得性感染和死亡率的预测因素。
结果
发生术后医院获得性感染的患者欧洲心脏手术风险评估系统评分较高（4.01%对2.51%；P=0.001），术前住院时间较长（9.44天对8.28天；P=0.049），住院时间也较长（28.41天对16.16天；P<0.001）。多变量分析后，术后医院获得性感染的预测因素包括术前住院时间较长（比值比1.024；95%置信区间1.005-1.044；P=0.009）、体重指数较高（比值比1.043；95%置信区间1.008-1.079；P=0.015）和体外循环时间较长（比值比1.007；95%置信区间1.003-1.012；P<0.001）。体外循环时间较长和术后医院获得性感染均与出院前较高的死亡率显著相关（比值比分别为1.012；95%置信区间1.006-1.019；P<0.001；和比值比2.418；95%置信区间1.385-4.233；P=0.001）。
结论
术前住院时间延长、体重指数和体外循环时间与术后医院获得性感染率升高相关。此外，较长的体外循环时间和术后医院获得性感染发生率是心脏手术后死亡率的重要预测因素。
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