Risk factors for pulmonary infection in patients after cardiac surgery: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAI Wenqian ,  WU Dequan , SUN Yue , LIU Bo

Nursing School of Anhui Medical University, The Second Hospital of Anhui Medical University, Hefei, 230032, P. R. China;

Corresponding author：

WU Dequan, Email: 2981288742@qq.com

Keywords：

Cardiac surgery; postoperative pulmonary infection; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202310069

Video：

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Objective To systematically evaluate the risk factors for pulmonary infection after cardiac surgery. Methods A computer search was performed to collect researches on risk factors for pulmonary infection in patients after cardiac surgery from the databases, including CNKI, Wanfang, VIP, CBM, PubMed, The Cochrane Library, EBSCO, CINAHL, Web of Science, EMbase from the inception to August 2023. Two researchers independently extracted data and assessed the literature according to the inclusion and exclusion criteria, and the quality of the literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed using RevMan 5.4 software. Results A total of 23 studies covering 24348 patients were selected, including 21 case-control studies and 2 cohort studies. The NOS scores were≥6 points. The results of meta-analysis showed that age (OR=2.16, 95%CI 1.80 to 2.59, P<0.001), smoking history (OR=1.91, 95%CI 1.67 to 2.18, P<0.001), pulmonary disease (OR=1.61, 95%CI 1.40 to 1.85, P<0.001), diabetes mellitus (OR=1.62, 95%CI 1.26 to 2.08, P<0.001), operation time (OR=2.54, 95%CI 1.86 to 3.46, P<0.001), cardiopulmonary bypass (CPB) (OR=3.78, 95%CI 2.11 to 6.77, P<0.001), CPB time (OR=2.30, 95%CI 1.94 to 2.71, P<0.001), blood transfusion (OR=2.55, 95%CI 2.04 to 3.20, P<0.001), postoperative mechanical ventilation time (OR=2.78, 95%CI 2.34 to 3.30, P<0.001), tracheal intubation time (OR=3.93, 95%CI 2.45 to 6.31, P<0.001) and repeated tracheal intubation (OR=8.74, 95%CI 4.17 to 18.30, P<0.001) were independent risk factors for pulmonary infection in patients after cardiac surgery. Conclusion Age, smoking history, pulmonary disease, diabetes mellitus, operation time, CPB, CPB time, blood transfusion, postoperative mechanical ventilation time, tracheal intubation time, and repeated tracheal intubation are risk factors for pulmonary infection in patients after cardiac surgery. It can be used as a reference to strengthen perioperative evaluation and nursing of high-risk patients and reduce the incidence of pulmonary infection.

Citation： CAI Wenqian, WU Dequan, SUN Yue, LIU Bo. Risk factors for pulmonary infection in patients after cardiac surgery: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1655-1662. doi: 10.7507/1007-4848.202310069 Copy

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1. Mali S, Haghaninejad H. Pulmonary complications following cardiac surgery. Arch Med Sci Atheroscler Dis, 2019, 4: e280-e285.
2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: A report from the American Heart Association. Circulation, 2023, 147(8): e93-e621.
3. 宋亚佩, 吴艳, 翟继卫. 心外科手术后医院感染特点及影响因素研究. 中国消毒学杂志, 2021, 38(11): 832-835.Song YP, Wu Y, Zhai JW. Clinical characteristic and influencing factors of nosocomial infections after cardiac surgery. Chin J Disinfect, 2021, 38(11): 832-835.
4. 毛文杰, 蒋蓉娟, 玉红, 等. 术中通气模式对体外循环下成人心脏手术后肺部并发症影响的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(3): 356-365.Mao WJ, Jiang RJ, Yu H, et al. A retrospective cohort study of the effect of intraoperative ventilation mode on pulmonary complications after cardiopulmonary bypass in adults undergoing cardiac surgery. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(3): 356-365.
5. 施舟, 陈振星, 王斌, 等. 心脏外科术后肺部并发症的危险因素. 临床麻醉学杂志, 2021, 37(10): 1023-1028.Shi Z, Chen ZX, Wang B, et al. Risk factors of postoperative pulmonary complications of cardiac surgery. J Clin Anesthesio, 2021, 37(10): 1023-1028.
6. 李霞, 马华怡, 赖军华, 等. 心脏外科术后肺部并发症研究进展. 实用医学杂志, 2023, 39(4): 510-513.Li X, Ma HY, Lai JH, et al. Research progress of pulmonary complications after cardiac surgery. J Pract Med, 2023, 39(4): 510-513.
7. 伊加提·司马义, 居来提·肉扎洪, 阿布都乃比·麦麦提艾力. 成人心外科围手术期肺部感染患者死亡的危险因素. 中华医院感染学杂志, 2022, 32(9): 1333-1336.Yijiati·Simayi, Julaiti·Rouzhahong, Abudunaibi·Maimaitiaili. Risk factors for death of adult cardiac surgery patients with perioperative pulmonary infection. Chin J Nosocomiol, 2022, 32(9): 1333-1336.
8. Zukowska A, Kaczmarczyk M, Listewnik M, et al. Impact of post-operative infection after CABG on long-term survival. J Clin Med, 2023, 12(9): 3125.
9. de la Varga-Martínez O, Gómez-Sánchez E, Muñoz MF, et al. Impact of nosocomial infections on patient mortality following cardiac surgery. J Clin Anesth, 2021, 69: 110104.
10. 张静, 李娟, 朱鑫瀛, 等. 心脏外科术后肺部并发症发生风险的列线图预测模型构建. 安徽医学, 2022, 43(9): 1012-1017.Zhang J, Li J, Zhu XY, et al. Construction of a nomogram prediction model for risk of pulmonary complications after cardiac surgery. Anhui Med J, 2022, 43(9): 1012-1017.
11. Ho CH, Chen YC, Chu CC, et al. Postoperative complications after coronary artery bypass grafting in patients with chronic obstructive pulmonary disease. Medicine (Baltimore), 2016, 95(8): e2926.
12. Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung, 2020, 198(6): 889-896.
13. 杨滢, 刘济. 心外科手术患者医院感染危险因素分析. 中国消毒学杂志, 2022, 39(3): 190-192.Yang Y, Liu J. Risk factors of nosocomial infection in patients undergoing cardiac surgery. Chin J Disinfect, 2022, 39(3): 190-192.
14. Gao Y, Wang C, Wang Y, et al. Establishment and validation of a nomogram to predict hospital-acquired infection in elderly patients after cardiac surgery. Clin Interv Aging, 2022, 17: 141-150.
15. Yao X, Li N, Lu R, et al. Development of a nomogram for predicting nosocomial infections among patients after cardiac valve replacement surgery. J Clin Nurs, 2023, 32(7-8): 1466-1475.
16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17. Wang D, Huang X, Wang H, et al. Risk factors for postoperative pneumonia after cardiac surgery: A prediction model. J Thorac Dis, 2021, 13(4): 2351-2362.
18. Allou N, Bronchard R, Guglielminotti J, et al. Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score. Crit Care Med, 2014, 42(5): 1150-1156.
19. Vidal C, Pasqualotto R, James A, et al. Predictive risk factors for postoperative pneumonia after heart transplantation. BMC Anesthesiol, 2020, 20(1): 8.
20. Kilic A, Ohkuma R, Grimm JC, et al. A novel score to estimate the risk of pneumonia after cardiac surgery. J Thorac Cardiovasc Surg, 2016, 151(5): 1415-1420.
21. El Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100(4): 729-736.
22. Hua LJ, Kong LX, Hu JN, et al. Perioperative risk factors for post-operative pneumonia after type A acute aortic dissection surgery. Curr Med Sci, 2023, 43(1): 69-79.
23. Vera Urquiza R, Bucio Reta ER, Berríos Bárcenas EA, et al. Risk factors for the development of postoperative pneumonia after cardiac surgery. Arch Cardiol Mex, 2016, 86(3): 203-207.
24. Topal AE, Eren MN. Risk factors for the development of pneumonia post cardiac surgery. Cardiovasc J Afr, 2012, 23(4): 212-215.
25. 邓佩琳, 胡振东, 吴秦风, 等. 老年冠心病冠状动脉搭桥术后肺部感染病原学及其影响因素. 中华医院感染学杂志, 2022, 32(11): 1702-1706.Deng PL, Hu ZD, Wu QF, et al. Etiology and influencing factors of pulmonary in elderly patients with coronary heart disease after coronary artery bypass grafting. Chin J Nosocomiol, 2022, 32(11): 1702-1706.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for pulmonary infection in patients after cardiac surgery: A systematic review and meta-analysis

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