Comparative assessment of the frequency and risk factors of purulent-septic infections in adult patients after various types of open and closed heart surgery

Abstract

BACKGROUND: The widespread increase in the number and types of cardiac surgery necessitate the study of frequency and risk factors of postoperative purulent-septic infections (PSIs).
 AIM: to provide a comparative assessment of the PSI frequency and risk factors in adult patients after various types of cardiac surgery.
 MATERIALS AND METHODS: Based on the cardiac surgery hospital materials, medical records of 4.815 patients over 18 years of age, who underwent open (n = 1.540) and closed (n = 3.275) heart surgeries within 1 year, were analyzed. The typical and prenosological forms of PSIs were taken into account in accordance with the epidemiological standard of case definition.
 RESULTS: The incidence rates for typical and prenosological PSI forms amounted to 39.6 and 72.7 per 1000 surgeries after open heart surgery, respectively, and 3.1 and 3.9 after minimally invasive endovascular surgical interventions, respectively. The main clinical forms of PSI after open and closed heart surgeries were surgical site infections, nosocomial pneumonia, urinary tract infection, and bloodstream infection. In an open heart surgery, the maximum incidence rates for typical and prenosological forms of PSIs were recorded after surgeries on the aorta and less often after heart valve replacement or coronary artery bypass grafting. The increased incidence rate after aortic surgery was mainly due to urinary tract infection and nosocomial pneumonia. In the case of closed heart surgery, no statistically significant differences were detected between the incidence rates of PSIs after coronary artery stenting, cardiac arrhythmia and carotid artery stenosis surgery, and other interventions. The duration of both the surgery itself and the subsequent patient stay in the intensive care unit was found to be important as risk factors for PSIs after cardiac surgery.
 CONCLUSION: The incidence rate of PSIs after open heart surgery is significantly higher than after closed heart surgery, which is mostly associated with the duration of surgical intervention and the subsequent patient stay in the intensive care unit.