Perioperative Pneumonia Research Articles

The incidence and factors associated with graft infection after aortic aneurysm repair

The reported rate of abdominal aortic graft infections (AGIs) is low, but its incidence and associated factors have not been evaluated on a population level. We hypothesized that AGI occurs more often in patients with periprocedural nosocomial infections and less often after endovascular aneurysm repair (EVAR). A retrospective cohort study was done of all patients undergoing abdominal aortic aneurysm (AAA) repair (1987-2005) in Washington State by using the Comprehensive Hospital Abstract Reporting System (CHARS) data. Nosocomial infection was defined as one or more of pneumonia, urinary tract infections, blood stream septicemia, or surgical site infection at the index admission. Readmissions and reintervention for graft infections defined AGIs excluding the diagnostic code of renal failure or those who appeared to have dialysis grafts. Between 1987 and 2005, 13,902 patients (mean age, 71.3 +/- 8.8 years; 90.8% men) underwent AAA repair (12,626 open, 1276 EVAR). The cumulative rate of AGIs in the cohort was 0.44%. The 2-year rate of AGI was 0.19% among open vs 0.16% in EVAR (P = .75) and 0.2% in both elective and nonelective patients. Open procedures had greater rates of perioperative pneumonia (11.1% vs 2.4%, P < .001), blood stream septicemia (1.6% vs 0.7%, P < .01), and surgical site infection (.5% vs 0%, P < .012) compared with EVAR. When individually analyzed, blood stream septicemia (.93% vs 18%, P = .014) and surgical site infection (1.61% vs 0.19%, P = .01) were significantly associated with AGIs. The median time to AGI was 3.0 years, and AGI presented sooner (< or =1.4 years) if nosocomial infection occurred at the index admission. This risk of developing AGI after open repair was highest in the first postoperative year (32% of all AGI occurred in year 1). In an adjusted model, blood stream septicemia was significantly associated with AGI (odds ratio, 4.2; 95% confidence interval, 1.5-11.8) The incidence of AGI was low, presented most commonly in the first postoperative year, and was similar among patients undergoing open AAA repair and EAVR. Patients with nosocomial infection had an earlier onset of AGI. The 2-year rate of AGI was significantly higher in patients who had blood stream septicemia and surgical site infection in the periprocedural hospitalization. These data may be helpful in directing surveillance programs for AIG.

Cardiopulmonary Bypass for Lung Transplantation in Cystic Fibrosis: Pilot Evaluation of Perioperative Outcome

The purpose of this study was to determine whether cardiopulmonary bypass (CPB) reduces the incidence of perioperative graft infection after lung transplantation in adults with cystic fibrosis (CF). Retrospective and observational. University hospital. Adults with CF who underwent lung transplantation (1998-2003). None. Cohort size was 26: group A (n = 10) who underwent CPB for implantation of both lungs, group B (n = 8) who underwent CPB only for implantation of the second lung, and group C (n = 8) who did not undergo CPB. The 3 cohort subgroups were similar (p > 0.05) in demographics, preoperative lung function, and anesthetic management. Group A had a lower incidence of perioperative pneumonia (p = 0.02). CPB exposure increased transfusion (B > A > C) of fresh frozen plasma and platelets but not packed red blood cells. There were no differences (p > 0.05) in clinical outcome as reflected by duration of mechanical ventilation, tracheal re-intubation, re-exploration for bleeding, sepsis, primary graft dysfunction, renal dysfunction, length of stay, and mortality. CPB is associated with decreased incidence of early graft infection after lung transplantation for adult CF when used for implantation of both lungs. This may be because of improved decontamination of the operative field before graft implantation.