AHRQ-Funded Researchers Recommend Interventions To Help Avoid Pneumonia in Bypass Surgery Patients

A bundle of precautions can limit inpatient pneumonia in patients undergoing coronary artery bypass graft, or CABG, an AHRQ-funded study has found. The precautions—including preoperative nasal and oral prophylaxis against infection, early extubation, encouraging patients to walk as soon as possible after surgery and avoiding postoperative bronchodilator therapy—were detailed in a study published in Annals of Thoracic Surgery. Researchers developed a set of recommendations for patients undergoing CABG, then encouraged implementation of the recommendations in 18 centers in Michigan—some of which had pneumonia frequencies as high as 6.8 percent before the precautions were tried. Among nearly 2,500 CABG patients for whom the recommendations were offered in 2016 and 2017, 98.4 percent had at least one recommendation implemented. Pneumonia occurred in 2.4 percent of all study patients. Access the abstract.

Evaluating the Impact of Pneumonia Prevention Recommendations After Cardiac Surgery

Affiliations

PMID: 32035918
DOI: 10.1016/j.athoracsur.2019.12.053

Abstract

Background: Pneumonia is the most prevalent healthcare-associated infection after coronary artery bypass grafting (CABG), but the relative effectiveness of strategies to reduce its incidence remains unclear. We evaluated the relationship between healthcare-associated infection recommendations and risk of pneumonia after CABG.

Methods: Pneumonia prevention practice recommendations were developed based on literature review and analysis of semistructured interviews with key health care personnel across centers with low (<5.9%), medium (5.9%-6.1%), and high (>6.1%) rates of pneumonia. These practices were implemented among 2482 patients undergoing CABG from 2016 to 2017 across 18 centers. The independent effect of each practice in reducing pneumonia was assessed using multivariable logistic regression, adjusting for baseline risk and center. A composite (bundle) score was calculated as the number of practices (0 to 4) each patient received.

Results: Recommended pneumonia prevention practices included lung protective ventilation management, early extubation, progressive ambulation, and avoidance of postoperative bronchodilator therapy. Pneumonia occurred in 2.4% of patients. Lung protective ventilation (adjusted odds ratio [ORadj], 0.45; 95% confidence interval [CI], 0.22-0.92), ambulation (ORadj, 0.08; 95% CI, 0.04-0.17), and postoperative ventilation of less than 6 hours (ORadj, 0.47; 95% CI, 0.26-0.87) were significantly associated with lower odds of pneumonia. Postoperative bronchodilator therapy (ORadj, 4.83; 95% CI, 2.20-10.7) was significantly associated with higher odds. Risk-adjusted rates of pneumonia, operative mortality, and intensive care unit length of stay were lower in patients with higher bundle scores (all P-trend < .01).

Conclusions: These pneumonia prevention recommendations may serve as effective targets for avoiding postoperative healthcare-associated infections.