Abstract 21370: Reducing Post-operative Bacterial Sepsis and Surgical Site Infections: Data from the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries
Objective: Using data collected through an international quality improvement collaborative, we aimed to identify risk factors for infection in developing countries, as well as to identify the impact that post-operative infection has on mortality.
Methods: Five sites in developing countries (Guatemala, India, China, Belarus, and Pakistan) entered data for congenital heart operations from September 2008 through December 2009 into a web-based central data repository as part of a quality improvement collaborative. The following data were collected: patient and procedural characteristics, in hospital death, and post-operative infections- defined as the occurrence of bacterial sepsis, superficial incisional infection, deep incisional infection, and/or mediastinitis. Multivariable logistical regression models and RACHS-1 methodology were used to identify risk factors for infection and the effect of infection on risk of death.
Results: Among 2,625 patients, cases were diverse: age ≤ 30d 6%, 31d-1y 28%, > 1y 66%; male 57%; malnourished 19%; cyanosis O2 sat mean 93 %; premature 5%; major non-cardiac anomalies 3 %; major chromosomal abnormality 5%; major medical illness 4%; overall infection rate 3.4% (surgical site infections 1.2 %; bacterial sepsis 2.8 %). In multivariate analysis, age at surgery (< 30d OR 3.7, 31d-1y OR 2.5), nutrition appearance (malnourished/emaciated OR 2.0), cyanosis (O2 sat <90 OR 2.4), and major non-cardiac anomaly (OR 3.0) were predictors for infection (all p ≤ 0.008). Increased complexity of procedure (i.e. RACHS category) increased risk of infection in univariate analysis, but was not an independent risk factor in multivariate analysis. Overall in-hospital mortality was 7%, and 37% among patients with infection (multivariate OR 9.0, p < 0.001).
Conclusions: The occurrence of a post-operative infection significantly increases risk for death following congenital heart operation. Young infants and those with poor nutrition, cyanosis and other non-cardiac anomalies were at particular risk. Strategies for reducing infections within developing world programs targeted at these patients should improve post-operative survival rates.
- © 2010 by American Heart Association, Inc.