Disability after cardiac surgery is the major predictor of infections occurring in the rehabilitation phase

Abstract

Background Few data have assessed the incidence, site and predictors of infections following cardiac surgery after discharge, particularly during an early rehabilitation phase. Aim To assess the epidemiology and predictors of infections occurring after cardiac surgery. Methods Data prospectively recorded from 5464 patients, consecutively included in a residential cardiac rehabilitation programme after cardiac surgery, were retrospectively analysed. Major infections were arbitrarily defined as (1) demonstration of bacterial growth in a sample collected to rule out a clinical suspected infection and (2) requiring an intravenous antibiotic treatment. Infections were grouped as (1) surgery-site infections (SSIs), and (2) healthcare associated infections (HCAIs). Barthel index was used as a measure of disability. Results Major infections occurred in 10.9% of patients, with SSI documented in 4.1% and HCAI in 6.8% of patients. In 50% of the cases, infections were diagnosed within four days from admission, 18 ± 16 days from intervention. A Barthel index <60 was the strongest independent predictor of SSI or HCAI. An older age, the presence of chronic renal failure or chronic obstructive pulmonary disease were all significantly associated with HCAI but not with SSI. Conclusions In a large cohort of patients, residual disability after cardiac surgery was the strongest independent predictor of infections. Disability is readily accessible, and can be used to recognize patients at higher risk of infections. The 10.9% rate of major infections observed after discharge from the surgical department confirms the importance of prolonging infection surveillance after discharge from the cardiac surgery department.