Interhospital variability in 180-day infections following cardiac surgery
Recommended Citation
Raza SS, Zhou S, Barnett NM, Chang CH, Hawkins RB, Alnajjar R, DeLucia A, 3rd, Schwartz CF, Thompson MP, Braun TM, Hammond EN, Wolverton J, Pagani FD, and Likosky DS. Interhospital Variability in 180-day Infections Following Cardiac Surgery. J Thorac Cardiovasc Surg 2025.
Document Type
Article
Publication Date
1-10-2025
Publication Title
The Journal of thoracic and cardiovascular surgery
Abstract
OBJECTIVE: To evaluate hospital-level variation in infections following cardiac surgery and develop and evaluate a 180-day infection quality metric.
METHODS: This study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was infection occurring within 180 days of surgery. Adjusted institutional infection rates were estimated using logistic regression with robust variance estimation. Terciles of observed/expected ratios were created to assess interhospital variability in infections and associated morbidity and mortality.
RESULTS: A total of 5466 operations were evaluated. The average patient age was 71.1 ± 7.8 years, 29.5% of the patients were female, and 4.8% were black. The infection rate was 21.2% overall and higher among females. Infection was associated with lower left ventricular ejection fraction, diabetes, severe chronic lung disease, cerebrovascular disease, and urgent operations (P < .0001 for all). The most common infection was pneumonia (8.5%). Adjusted infection rates varied 39.5% across hospitals (range, 7.2%-46.7%). Patients treated in hospitals in the highest tercile of observed/expected infection ratio had a higher rate of associated discharge to extended care/rehabilitation (27.9% vs 24.7%, P < .0001) but comparable stroke and mortality risk compared to patients treated in hospitals in the lowest tercile.
CONCLUSIONS: One in 5 Medicare beneficiaries develop a 180-day infection following cardiac surgery, with rates varying 39.5% across hospitals. Patients at higher versus lower O:E tercile hospitals were more commonly discharged to extended care/rehabilitation settings, although rates of stroke and mortality were equivalent in the 2 groups. Collaborative learning interventions may be warranted to advance the observed variability in 180-day infections.
PubMed ID
39800274
ePublication
ePub ahead of print
