title: Postoperative Infections are Associated with Increased Risk of Cardiac Events in Vascular Patients.
abstract: BACKGROUND
  Despite advances in perioperative care, the rate of cardiac events in vascular patients remains high. We have previously shown that infections in trauma patients are associated with higher rates of subsequent cardiac complications, likely due to the additive effect of a second hit of an infection following the trauma. The aim of this study was to investigate whether there is an association between postoperative infections and subsequent cardiac events in vascular patients.
  
  
  METHODS
  A 5-year retrospective review of demographics, comorbidities, operative interventions, infectious, and cardiac events in all vascular patients who underwent an operative intervention at a single tertiary referral center was performed. In patients with clinical suspicion of myocardial injury, myocardial damage was defined as troponin >0.15 ng/mL and myocardial infarction (MI) as troponin >1 ng/mL. Pneumonia was diagnosed using bronchoalveolar lavage (BAL) and considered positive if BAL fluid culture contained >10,000 colony-forming units (cfu). Urinary tract infection (UTI) was diagnosed if the urine culture contained >100,000 cfu. All other infections were diagnosed by culture data. Regression analysis was performed to assess risk of cardiac events as a function of infections adjusting for age, gender, and comorbidities.
  
  
  RESULTS
  We analyzed 1,835 vascular operative interventions with the mean age of the cohort 65.5 years (65.9% male). The overall infection rate was 13.2%, with UTI being the most common (60.3%). The overall rate of myocardial damage was 8.1% and the rate of MI 3.8%. Rates of both myocardial damage (15.5 vs. 7.7%; P = 0.0015) and MI (7.1 vs. 3.4%; P = 0.018) were significantly higher in patients with infections, compared to those without infections. Adjusting for age, gender, medical comorbidities, open versus endovascular cases as well as statin and steroid use, patients with UTI were more likely to subsequently develop either myocardial damage (odds ratio [OR] = 3.57 [95% confidence interval = 1.51-8.45]) or MI (OR = 4.20 [1.23-14.3]). A similar association was noted between any infections and either myocardial damage (OR = 2.97 [1.32-6.65]) or MI (OR = 4.31 [1.44-12.94]).
  
  
  CONCLUSIONS
  We herein describe an association between postoperative infections, most commonly UTI, and subsequent cardiac events. Efforts should be made to minimize the risk of developing infections to ensure cardioprotection in vascular patients during perioperative period.
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI. Electronic address: tchun1@lifespan.org.
authors.forename: Tristen T
authors.initials: TT
authors.lastname: Chun
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Garcia-Toca
authors.affiliation: Alpert Medical School of Brown University, Providence, RI.
authors.forename: James F
authors.initials: JF
authors.lastname: Eng
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI; Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Slaiby
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI; Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Marcaccio
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: William G
authors.initials: WG
authors.lastname: Cioffi
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI; Division of Surgical Research, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: Daithi S
authors.initials: DS
authors.lastname: Heffernan
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects*