The Journal of Thoracic and Cardiovascular Surgery
Perioperative ManagementAssociation of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections
Graphical Abstract
Section snippets
Data Source and Study Population
In this retrospective single-center observational study, after Institutional Review Board approval (protocol #2000030764. Date of approval: September 2, 2021), patients who underwent cardiopulmonary bypass for CABG or valve repair or replacement at the Yale-New Haven Health System from January 1, 2016, to April 1, 2021, were included for analysis. The protocol was deemed exempt from the requirement of informed consent. Given the key hypothesis was to assess whether the components of a more
Baseline Characteristics
The study cohort comprised 2829 patients, with a mean (SD) age of 66.1 (11.5) years, and 881 (31.1%) were female. A total of 1085 patients (38.3%) received STS nonadherent antibiotics. In univariate analyses, men received significantly higher STS concordant antibiotic prophylaxis than women (1289 [66.2%] vs 455 [51.6%], (P < .01)). The mean age (± SD) was similar in the 2 groups: 66.2 (10.7) and 65.9 (12.7) years, respectively. Patients who received STS nonadherent antibiotic care had a higher
Discussion
Our results demonstrate that both STS guideline nonadherence and postoperative infections/sepsis after cardiac surgeries are common, with the latter complicating approximately 7.5% of cardiac surgeries in our dataset. Noncompliance with the 4 aspects of STS antibiotic guidelines appeared to have differential associations with our outcomes of interest, with antibiotic timing nonadherence associated with postoperative infection, and weight-adjusted dosing nonadherence associated with sepsis and
Conclusions
The findings of our study suggest that adherence to STS metrics of timing and weight-adjusted dosing may have incremental benefits in reducing infections, postoperative sepsis, and 30-day mortality after cardiac surgery. However, our observational findings are hypothesis generating and do not confer causation. In this context, our results point to the need of future larger studies to understand barriers to guideline adherence and to better understand which aspects of antibiotic administration
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Cited by (0)
The work on this study was supported in part by grant T32GM086287 from the National Institute of General Medical Sciences (NIGMS) and by grant R01HS029172 from the Agency for Healthcare Research and Quality (AHRQ). The opinions expressed are those of the authors and do not necessarily represent the thoughts or opinions of NIGMS, National Institutes of Health, AHRQ, or the United States government.
Institutional Review Board Approval: This work was performed with prior approval of the Yale Human Investigations Committee; protocol #2000030764. Date of approval: September 2, 2021. The protocol was deemed exempt from the requirement of informed consent.