title: Proportion of mortality caused by severe hospital-acquired infection in open-heart surgery.
abstract: OBJECTIVE
  To investigate severe hospital-acquired infection as an independent risk factor for in-hospital mortality and the proportion of mortality caused by severe hospital-acquired infections in patients under going open-heart surgery.
  
  
  METHODS
  A 1,300-bed teaching hospital in Spain.
  
  
  METHODS
  A retrospective cohort study of 702 patients who underwent open-heart surgery procedures between January 1989 and December 1991. The mean age was 57 years, and 68% of the subjects were men. Of the 702 patients, 42% underwent a valve operation, 41% had coronary artery bypass grafting, 4% had both a valve operation and coronary artery bypass grafting, 5% underwent repair of congenital heart disease, and 8% had other surgical procedures.
  
  
  RESULTS
  The cumulative incidence of severe hospital infection was 16.8%. The overall mortality rate was 5.4%. The mortality risk was 5.15 times higher in nosocomially infected patients than in uninfected patients. In addition, univariate analysis revealed up to 18 perioperative variables associated with in-hospital mortality. By multiple logistic regression, we identified four factors that independently predicted increased risk of mortality: preoperative New York Heart Association functional class level IV; long duration of cardiopulmonary bypass; low cardiac output syndrome; and severe hospital-acquired infection. The proportion of mortality caused by severe hospital-acquired infection in the cohort was 31.1%.
  
  
  CONCLUSIONS
  Severe hospital-acquired infection is a principal factor in in-hospital mortality. One third of all deaths are caused by infection. Major efforts should be devoted to the prevention and control of severe nosocomial infections in open-heart surgery patients to prevent mortality.
authors.affiliation: Ramón y Cajal Hospital, University of Alcalá de Henares, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Asensio
authors.forename: J
authors.initials: J
authors.lastname: Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D002303:Cardiac Output, Low / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006746:Hospital Bed Capacity, 500 and over; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology