Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica

Abstract

Background: Although coronary artery bypass grafting (CABG) is a good alternative therapy in severe arterial disease, it may evolve with complications, especially infections. Objectives: To determine the incidence of infection in post-CABG and its clinical predictors in a cardiology reference center in Brazil. Methods: Concurrent cohort study. Data were collected from all patients undergoing CABG between January/2004 and February/2006, excluding emergency surgery, absent record of blood glucose levels preoperatively and infection prior to surgery. Statistical analysis: Student's t test, chi square, logistic regression. Results: We evaluated 717 Patients, 11 ± 61.9 years old, were men 67.1%, 29.6% with diabetes, of whom 137 (19.1%) developed infection (62% respiratory, 25% superficial wound, urinary 9.5%, 3.6% deep wound). Diabetes was more prevalent in those who developed infection, as well as prolonged time of indwelling central venous catheter (79.3 ± 40.5 vs. 61.0 ± 19.3 hours, P <0.001). After multivariate analysis (model adjusted for dyslipidemia, hypertension, smoking and leukocytes), both diabetes (OR 4.18 [2.60-6.74]), prolonged central venous line (1019 OR [1:00 to 1:02] and cardiac catheterism (OR 03.02 [1.14-3.60] remained predictors of infection. While diabetes is associated with a higher percentage of infections (P <0.001), preoperative serum glucose was not associated with increased risk of infection. Conclusions: Diabetes and permanence of central venous catheters were associated with development of infection in post-CABG. The preoperative blood glucose was not a predictor of risk of infection. It is probably necessary to study with great detail glycemic control trans- and postoperatively.