Early 30 day postoperative morbidity and rehospitalizations after coronary artery bypass grafting

Cilj: Cilj ovog istraživanja je bio da se identifikuju značajni razlozi ranih rehospitalizacija u 30 dana nakon hiruške revaskularizacije miokarda (HRM), kao i glavne postoperativne komplikacije i da se uporede stope ranih rehospitalizacija uzrokovanih hiruškim infekcijama (HI) pre i nakon implementacije internacionalnih preporuka za hirušku antibiotsku profilaksu. Metod: Analizirali smo 2,225 bolesnika kojima je urađena HRM u period između Januara 2017. i Decembra 2019. god., koji su imali smernicama vođenu antibiotsku profilaksu (SVAP = 568) ili institucionalnu antibiotsku profilaksu (ne-SVAP = 1,657). Primarni događaj je bio kompozit od događaja infekcije sternalne rane i rane mesta uzimanja graftova. Sekundarni događaji su bili pojedinačne komponente primarnog kompozitnog događaja, stopa HI u indexnoj hospitalizaciji i produžena indexna hospitalizacija (PIH) > 7 dana. Primenjeno je uparivanje bolesnika po sličnosti (Propensity Score Matching) za finalno upoređivanje i analizu. Rezultati: Pre iplementacije SVAP, najčešći razlog ranih rehospitalizacije su bile HI, izazivajući 58.2% svih rehospitalizacija u 30 dana nakon HRM, zajedno sa nehiruškim infekcijama i atrijalnom fibrilacijom, koje su ujedno bile i glavni razlozi produžene indexne hospitalizacije. Od 429 uparenih bolesnika, 48 bolesnika iz SVAP grupe i 67 bolesnika iz ne-SVAP grupe su bili rehospitalizovani u 30 dana nakon HRM zbog bilo kog razloga (11.2 vs. 15.6%, p = 0.048). U SVAP grupi je utvrđeno smanjnje stope rehospitalizacija zbog HI, ali razlika nije dostigla statističku značajnost (7.4 vs. 10.0%, p = 0.069). Adherenca prema SVAP je bila povezana sa smanjenjem rizika od HI tokom indexne hospitalizacije i PIH (19.6 vs. 26.6%, p = 0.015). Zaključak: U ovom istraživanju savremene kliničke prakse, samo adherence prema SVAP nije bila dovoljna mera za smanjnje ranih rehospitalizacija zbog HI. Prezentovani rezultati ukazuju da je u budućnosti neophodno istražiti dodatne faktore koji doprinose nastanku HI nakon završetka indexne hospitalizacije.Objectives: The present study aimed to identify significant causes of readmission within 30 days following coronary artery bypass graft (CABG) surgery, as well as main postoperative complications, and to compare readmission incidence related to surgical site infections (SSIs) before and after implementing international recommendations for antibiotic prophylaxis. Methods: 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. Results: Before implementing GDAP, the most frequent reason for readmission were SSIs, causing 58.2% of all readmissions within 30 days, along with non-surgical infections and atrial fibrillation, which were et the same time main causes for prolonged index hospitalization. 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). Conclusions: 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