title: Hospitalization before surgery increases risk for postoperative infections.
abstract: OBJECTIVE
  Exposure to a health care facility before surgery may increase risk for postoperative infections. Our objectives were to (1) determine whether the prevalence of postoperative infections was higher among patients who were hospitalized before cardiac surgery, (2) identify risk factors for infection, and (3) evaluate in-hospital outcomes.
  
  
  METHODS
  A total of 32,707 patients underwent cardiac surgery from January 1, 2000, to January 1, 2011. Forty percent (13,107) were hospitalized before their surgery date or were transfers from other health care facilities, and 60% (19,600) were same-day admissions. The primary outcome consisted of a composite infection: pneumonia, sepsis, surgical site infection, and urinary tract infection. The secondary outcome was in-hospital death. The propensity method was used to compare infectious complications and mortality between groups.
  
  
  RESULTS
  Overall infectious complications occurred in 2327 patients (7.1%). Overall composite and individual infections decreased over the study period (P for trend <.0001). Among 7814 propensity-matched pairs, 522 infections (6.7%) occurred in the same-day admission group versus 676 (8.7%) in the prior hospitalization group, P<.0001. In-hospital mortality was 1.5% (n=120) for the same-day admission group versus 2.8% (n=221) for the prior hospitalization group (P<.0001).
  
  
  CONCLUSIONS
  Although the risk of infection decreased over time, the relationship between exposure to a health care facility before surgical intervention and higher infection risk remained substantial. Further investigation into processes of care surrounding infection control is necessary to reduce postoperative infections and associated morbidity.
authors.affiliation: Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Marta
authors.initials: M
authors.lastname: Kelava
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Robich
authors.affiliation: Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Penny L
authors.initials: PL
authors.lastname: Houghtaling
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.affiliation: Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Gordon
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: kochc@ccf.org.
authors.forename: Colleen G
authors.initials: CG
authors.lastname: Koch
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors