• Gorav Ailawadi, Helena L Chang, Patrick T O'Gara, Karen O'Sullivan, Woo Y Joseph YJ Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif., Joseph J DeRose, Michael K Parides, Vinod H Thourani, Sophie Robichaud, A Marc Gillinov, Wendy C Taddei-Peters, Marissa A Miller, Louis P Perrault, Robert L Smith, Lyn Goldsmith, Keith A Horvath, Kristen Doud, Kim Baio, Annetine C Gelijns, Alan J Moskowitz, Emilia Bagiella, John H Alexander, and Alexander Iribarne.
• Cardiothoracic Surgery, University of Virginia, Charlottesville, Va.
• J. Thorac. Cardiovasc. Surg. 2017 Jun 1; 153 (6): 1384-1391.e3.

RationalePneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures.ObjectivesTo prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for postoperative pneumonia and estimate its impact on clinical outcomes.MethodsA total of 5158 adult cardiac surgery patients were enrolled prospectively in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model and length of stay by a multistate model.Measurements And Main ResultsThe cumulative incidence of pneumonia was 2.4%, 33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time, and left ventricular assist device/heart transplant were risk factors. Ventilation time (24-48 vs ≤24 hours; hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI, 1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI, 1.08-1.26) increased the risk of pneumonia. Prophylactic use of second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective. Pneumonia was associated with a marked increase in mortality (HR, 8.89; 95% CI, 5.02-15.75) and longer length of stay of 13.55 ± 1.95 days (bootstrap 95% CI, 10.31-16.58).ConclusionsPneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.

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