title: Prolonged effect of postoperative infectious complications on survival after cardiac surgery.
abstract: BACKGROUND
  Whether patients having infections after cardiac surgery are at a survival disadvantage after hospital discharge is unclear. Our objectives were (1) to identify characteristics of such patients and (2) to determine whether this complication is associated with increased mortality beyond hospital discharge.
  
  
  METHODS
  In all, 30,414 patients were discharged after isolated coronary artery bypass grafting, valve, ascending aorta repair, or combined procedures from January 2000 to January 2011. Surgical site infection, septicemia, pneumonia, and urinary tract infection occurred in 1,868 patients (6.1%). Propensity matching was used to account for differences in perioperative characteristics and postoperative in-hospital events between these patients and those not having postoperative infections, to give 1,593 propensity-matched pairs. Time-related mortality and instantaneous risk were compared.
  
  
  RESULTS
  Surgical site infection occurred in 122 patients (0.40%), sternal wound infection in 263 (0.86%), septicemia in 656 (2.2%), urinary tract infection in 853 (2.8%), and pneumonia in 513 (1.7%). Infections were associated with older age, female sex, larger body mass index, and multiple comorbidities. Among 1,593 propensity-matched pairs, postdischarge survival at 6 months and at 1, 5, and 10 years, respectively, was 89%, 86%, 67%, and 45% for patients without infections, and 86%, 83%, 63%, and 43% (p = 0.008) for patients with infections. Survival differences resulted from a higher, but gradually declining, early instantaneous risk during the first year after surgery. Elevated risk was of shorter duration for surgical site infections than for other infections.
  
  
  CONCLUSIONS
  Postoperative infection is associated with a high-risk patient profile, and risk of death is elevated early after hospital discharge. Reasons for this prolonged effect are unclear.
authors: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Michael P
authors: MP
authors: Robich
authors: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Joseph F
authors: JF
authors: Sabik
authors: Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Penny L
authors: PL
authors: Houghtaling
authors: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Marta
authors: M
authors: Kelava
authors: Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Steven
authors: S
authors: Gordon
authors: 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: Eugene H
authors: EH
authors: Blackstone
authors: Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: ckoch11@jhmi.edu.
authors: Colleen G
authors: CG
authors: Koch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011014:Pneumonia / Q000453:epidemiology; D057216:Propensity Score; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D014552:Urinary Tract Infections / Q000453:epidemiology