Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Wei ^1,2 , CHEN Ying ^1,3 , YU Hong ¹ , JIN Liang ^1,4 ,  YU Hai ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Anesthesiology, First People's Hospital of Neijiang City, Neijiang, 641000, Sichuan, P. R. China;
3. Department of Anesthesiology, Liangshan Hospital of Integrated Traditional Chinese and Western Medicine, Liangshan, 615000, Sichuan, P. R. China;
4. Department of Anesthesiology, Leshan People's Hospital, Leshan, 614000, Sichuan, P. R. China;

Corresponding author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Volatile anesthetics; sevoflurane; desflurane; intravenous anesthetics; propofol; cardiopulmonary bypass; cardiac surgery; postoperative infection

DOI：

10.7507/1007-4848.202108020

Video：

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Objective To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.

Citation： TIAN Wei, CHEN Ying, YU Hong, JIN Liang, YU Hai. Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 585-591. doi: 10.7507/1007-4848.202108020 Copy

1.	Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
2.	Landis RC, Brown JR, Fitzgerald D, et al. Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: A critical review of the evidence base. J Extra Corpor Technol, 2014, 46(3): 197-211.
3.	Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
4.	Heydarpour F, Rahmani Y, Heydarpour B, et al. Nosocomial infections and antibiotic resistance pattern in open-heart surgery patients at Imam Ali Hospital in Kermanshah, Iran. GMS Hyg Infect Control, 2017, 12: Doc07.
5.	Gelijns AC, Moskowitz AJ, Acker MA, et al. Management practices and major infections after cardiac surgery. J Am Coll Cardiol, 2014, 64(4): 372-381.
6.	Kollef MH, Sharpless L, Vlasnik J, et al. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest, 1997, 112(3): 666-675.
7.	李天佐. 麻醉管理对手术患者预后的影响围术期麻醉管理与术后感染. 北京医学, 2014, 36(8): 619-620.
8.	Cruz FF, Rocco PRM, Pelosi P. Immunomodulators in anesthesia. Curr Opin Anaesthesiol, 2021, 34(3): 357-363.
9.	Inada T, Yamanouchi Y, Jomura S, et al. Effect of propofol and isoflurane anaesthesia on the immune response to surgery. Anaesthesia, 2004, 59(10): 954-959.
10.	Liu S, Gu X, Zhu L, et al. Effects of propofol and sevoflurane on perioperative immune response in patients undergoing laparoscopic radical hysterectomy for cervical cancer. Medicine (Baltimore), 2016, 95(49): e5479.
11.	Tsuchiya M, Shiomoto K, Mizutani K, et al. Reduction of oxidative stress a key for enhanced postoperative recovery with fewer complications in esophageal surgery patients: Randomized control trial to investigate therapeutic impact of anesthesia management and usefulness of simple blood test for prediction of high-risk patients. Medicine (Baltimore), 2018, 97(47): e12845.
12.	Kalimeris K, Christodoulaki K, Karakitsos P, et al. Influence of propofol and volatile anaesthetics on the inflammatory response in the ventilated lung. Acta Anaesthesiol Scand, 2011, 55(6): 740-748.
13.	Xu WY, Wang N, Xu HT, et al. Effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients undergone esophagectomy. Int J Clin Exp Pathol, 2013, 7(1): 272-279.
14.	Zhao W, Zhou S, Yao W, et al. Propofol prevents lung injury after intestinal ischemia-reperfusion by inhibiting the interaction between mast cell activation and oxidative stress. Life Sci, 2014, 108(2): 80-87.
15.	Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
16.	O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030.
17.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
18.	Hidalgo Fabrellas I, Rebollo Pavón M, Planas Canals M, et al. Incidence of urinary tract infections after cardiac surgery: Comparative study accordind to catheterization device. Enferm Intensiva, 2015, 26(2): 54-62.
19.	von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
20.	Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, 2019, 154(8): 755-766.
21.	Stollings LM, Jia LJ, Tang P, et al. Immune modulation by volatile anesthetics. Anesthesiology, 2016, 125(2): 399-411.
22.	Takemoto Y. Dose effects of propofol on hemodynamic and cytokine responses to endotoxemia in rats. J Anesth, 2005, 19(1): 40-44.
23.	Hsu BG, Yang FL, Lee RP, et al. Effects of post-treatment with low-dose propofol on inflammatory responses to lipopolysaccharide-induced shock in conscious rats. Clin Exp Pharmacol Physiol, Jan-Feb 2005, 32(1-2): 24-29.
24.	Hsing CH, Chou W, Wang JJ, et al. Propofol increases bone morphogenetic protein-7 and decreases oxidative stress in sepsis-induced acute kidney injury. Nephrol Dial Transplant, 2011, 26(4): 1162-1172.
25.	Hsu HT, Tseng YT, Hsu YY, et al. Propofol attenuates lipopolysaccharide-induced reactive oxygen species production through activation of Nrf2/GSH and suppression of NADPH oxidase in human alveolar epithelial cells. Inflammation, 2015, 38(1): 415-423.
26.	An K, Shu H, Huang W, et al. Effects of propofol on pulmonary inflammatory response and dysfunction induced by cardiopulmonary bypass. Anaesthesia, 2008, 63(11): 1187-1192.
27.	Koo BW, Sim JB, Shin HJ, et al. Surgical site infection after colorectal surgery according to the main anesthetic agent: A retrospective comparison between volatile anesthetics and propofol. Korean J Anesthesiol, 2016, 69(4): 332-340.

1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
2. Landis RC, Brown JR, Fitzgerald D, et al. Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: A critical review of the evidence base. J Extra Corpor Technol, 2014, 46(3): 197-211.
3. Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
4. Heydarpour F, Rahmani Y, Heydarpour B, et al. Nosocomial infections and antibiotic resistance pattern in open-heart surgery patients at Imam Ali Hospital in Kermanshah, Iran. GMS Hyg Infect Control, 2017, 12: Doc07.
5. Gelijns AC, Moskowitz AJ, Acker MA, et al. Management practices and major infections after cardiac surgery. J Am Coll Cardiol, 2014, 64(4): 372-381.
6. Kollef MH, Sharpless L, Vlasnik J, et al. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest, 1997, 112(3): 666-675.
7. 李天佐. 麻醉管理对手术患者预后的影响围术期麻醉管理与术后感染. 北京医学, 2014, 36(8): 619-620.
8. Cruz FF, Rocco PRM, Pelosi P. Immunomodulators in anesthesia. Curr Opin Anaesthesiol, 2021, 34(3): 357-363.
9. Inada T, Yamanouchi Y, Jomura S, et al. Effect of propofol and isoflurane anaesthesia on the immune response to surgery. Anaesthesia, 2004, 59(10): 954-959.
10. Liu S, Gu X, Zhu L, et al. Effects of propofol and sevoflurane on perioperative immune response in patients undergoing laparoscopic radical hysterectomy for cervical cancer. Medicine (Baltimore), 2016, 95(49): e5479.
11. Tsuchiya M, Shiomoto K, Mizutani K, et al. Reduction of oxidative stress a key for enhanced postoperative recovery with fewer complications in esophageal surgery patients: Randomized control trial to investigate therapeutic impact of anesthesia management and usefulness of simple blood test for prediction of high-risk patients. Medicine (Baltimore), 2018, 97(47): e12845.
12. Kalimeris K, Christodoulaki K, Karakitsos P, et al. Influence of propofol and volatile anaesthetics on the inflammatory response in the ventilated lung. Acta Anaesthesiol Scand, 2011, 55(6): 740-748.
13. Xu WY, Wang N, Xu HT, et al. Effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients undergone esophagectomy. Int J Clin Exp Pathol, 2013, 7(1): 272-279.
14. Zhao W, Zhou S, Yao W, et al. Propofol prevents lung injury after intestinal ischemia-reperfusion by inhibiting the interaction between mast cell activation and oxidative stress. Life Sci, 2014, 108(2): 80-87.
15. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
16. O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030.
17. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
18. Hidalgo Fabrellas I, Rebollo Pavón M, Planas Canals M, et al. Incidence of urinary tract infections after cardiac surgery: Comparative study accordind to catheterization device. Enferm Intensiva, 2015, 26(2): 54-62.
19. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
20. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, 2019, 154(8): 755-766.
21. Stollings LM, Jia LJ, Tang P, et al. Immune modulation by volatile anesthetics. Anesthesiology, 2016, 125(2): 399-411.
22. Takemoto Y. Dose effects of propofol on hemodynamic and cytokine responses to endotoxemia in rats. J Anesth, 2005, 19(1): 40-44.
23. Hsu BG, Yang FL, Lee RP, et al. Effects of post-treatment with low-dose propofol on inflammatory responses to lipopolysaccharide-induced shock in conscious rats. Clin Exp Pharmacol Physiol, Jan-Feb 2005, 32(1-2): 24-29.
24. Hsing CH, Chou W, Wang JJ, et al. Propofol increases bone morphogenetic protein-7 and decreases oxidative stress in sepsis-induced acute kidney injury. Nephrol Dial Transplant, 2011, 26(4): 1162-1172.
25. Hsu HT, Tseng YT, Hsu YY, et al. Propofol attenuates lipopolysaccharide-induced reactive oxygen species production through activation of Nrf2/GSH and suppression of NADPH oxidase in human alveolar epithelial cells. Inflammation, 2015, 38(1): 415-423.
26. An K, Shu H, Huang W, et al. Effects of propofol on pulmonary inflammatory response and dysfunction induced by cardiopulmonary bypass. Anaesthesia, 2008, 63(11): 1187-1192.
27. Koo BW, Sim JB, Shin HJ, et al. Surgical site infection after colorectal surgery according to the main anesthetic agent: A retrospective comparison between volatile anesthetics and propofol. Korean J Anesthesiol, 2016, 69(4): 332-340.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study

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