Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

Impact of the Circadian Rhythm and Seasonal Changes on the Outcome of Cardiovascular Interventions

The activities of living beings fluctuate according to seasonal changes and circadian rhythms. The interaction of organisms with their environment, notably weather conditions and night-day cycles, modulate homeostatic mechanisms and influence physiological responses in stressful situations. In humans, it is well established that cardiovascular events such as myocardial infarction, stroke and acute heart failure more frequently occur in winter than in summer season (non-tropical regions) and in the morning than in the evening. While the effects of cardiovascular medications vary during the day, the influence of circadian rhythms on the outcomes of invasive interventions is the subject of conflicting debates. This paper analyzes the impact of seasonal variability and circadian rhythms on physiological responses and the occurrence of complications in cardiac surgery and interventional cardiology.

The Effects of Seasonal Variation on the Outcomes of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Background

The impact of seasonal patterns on the mortality and morbidity of surgical patients with cardiovascular diseases has gained increasing attention in recent years. However, whether this seasonal variation extends to cardiovascular surgery outcomes remains unknown. This study sought to evaluate the effects of seasonal variation on the short-term outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG).

Methods

This study identified all patients undergoing elective OPCABG at a single cardiovascular center between January 2020 and December 2020. Patients were divided into four groups according to the season of their surgery. The primary outcome was the composite incidence of mortality and morbidity during hospitalization. Secondary outcomes included chest tube drainage (CTD) within 24 h, total CTD, chest drainage duration, mechanical ventilation duration, and postoperative length of stay (LOS) in the intensive care unit (ICU) and hospital.

Results

Winter and spring surgeries were associated with higher composite incidence of mortality and morbidities (26.8% and 18.0%) compared to summer (15.7%) and autumn (11.1%) surgeries (p < 0.05). Spring surgery had the highest median CTD within 24 hours after surgery (640 mL), whereas it also exhibited the lowest total CTD (730 mL) (p < 0.05). Chest drainage duration was longer in spring and summer than in autumn and winter (p < 0.05). While no significant differences were observed in mechanical ventilation duration and hospital stay among the four seasons, the LOS in the ICU was longer in summer than in autumn (88 h vs. 51 h, p < 0.05).

Conclusions

The OPCABG outcomes might exhibit seasonal patterns in patients with coronary heart disease.

Impact of Enhanced in-Hospital Infection Prevention During the COVID-19 Pandemic on Postoperative Pneumonia in Older Surgical Patients

Purpose

We aimed to investigate the impact of enhanced in-hospital infection prevention during the coronavirus disease 2019 (COVID-19) pandemic on postoperative pneumonia in older surgical patients.

Patients and Methods

We retrospectively reviewed the electronic medical records of consecutive patients ≥70 years who underwent elective surgery between 2017 and 2021 at our institution. All perioperative variables were retrieved from the electronic medical records. The primary outcome was new-onset postoperative pneumonia during the hospitalization period. Since February 2020, our institution implemented a series of policies to enhance infection prevention, hence patients were divided into groups according to whether they underwent surgery before or during the COVID-19 pandemic. An interrupted time series analysis was performed to evaluate the difference between pre- and post-intervention slopes of the primary outcome.

Results

Among the 29,387 patients included in the study, 10,547 patients underwent surgery during the COVID-19 pandemic. Although there was a decreasing trend of the monthly incidence rate of postoperative pneumonia compared to before the COVID-19 pandemic, there was no statistical significance in the trend (slope before COVID-19 period: β-coefficient, -0.007; 95% CI, -0.022 to 0.007).

Conclusion

Our study revealed that enhanced in-hospital infection prevention implemented to manage the COVID-19 pandemic did not significantly affect the decreasing trend of postoperative pneumonia at our institution.

Nosocomial Extracardiac Infections After Cardiac Surgery

Purpose of Review

Nosocomial extracardiac infections after cardiac surgery are a major public health issue affecting 3–8.2% of patients within 30–60 days following the intervention.

Recent Findings

Here, we have considered the most important postoperative infective complications that, in order of frequency, are pneumonia, surgical site infection, urinary tract infection, and bloodstream infection. The overall picture that emerges shows that they cause a greater perioperative morbidity and mortality with a longer hospitalization time and excess costs. Preventive interventions and corrective measures, diminishing the burden of nosocomial extracardiac infections, may reduce the global costs. A multidisciplinary team may assure a more appropriate management of nosocomial extracardiac infections leading to a reduction of hospitalization time and mortality rate.

Summary

The main and most current data on epidemiology, prevention, microbiology, diagnosis, and management for each one of the most important postoperative infective complications are reported. The establishment of an antimicrobial stewardship in each hospital seems to be, at the moment, the more valid strategy to counteract the challenging problems.