550 National Surveillance of Surgical Site Infections after Coronary Artery Bypass Grafting in Norway: Incidence and Risk Factors

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Thale C. Berg, MPH , Norwegian Institute of Public Health, Oslo, Norway
Nina K. Sorknes, MPH , Norwegian Institute of Public Health, Oslo, Norway
Knut E. Kjørstad, MD, DDS, PhD , University Hospital North Norway, Tromsø, Norway
Per Espen Akselsen, MD , Haukeland University Hospital, Bergen, Norway
Bjørn Edvard Seim, MD , Oslo University Hospital Ullevål, Oslo, Norway
Hege Line M. Løwer, MOH , Norwegian Institute of Public Health, Oslo, Norway
Maryann N. Stenvik, PA , St. Olav University Hospital, Trondheim, Norway
Hanne Merete Eriksen, MPH , Norwegian Institute of Public Health, Oslo, Norway
Background: A mandatory national surveillance system for surgical site infections (SSIs) following certain surgical procedures, including coronary artery bypass grafting (CABG) was introduced in Norway in 2005.

Objective: The objectives of this study were to measure national baseline incidence rates of SSIs after CABG, describe the characteristics of the patients and procedures and identify possible risk factors for infection.

Methods: Between 2005-2009 all hospitals that perform CABG were invited to assess all patients undergoing CABG surgery during designated three-month periods for SSIs. The hospitals evaluated infection status at discharge and 30 days after surgery by sending post-discharge questionnaires to all patients. We calculated incidence proportions and analysed risk ratios for different risk factors. We used the National Nosocomial Infection Surveillance (NNIS) risk index to stratify the patients.

Results: Of all the patients registered, 2440 (92 %) were completely followed up for 30 days and included in the study. One hundred twenty-four sternal and 217 harvest site infections were registered, giving incidence proportions of 5.1 % and 8.9 %, respectively. Over 95% of infections occurred after discharge. The mean number of days to infection was 15 days (sternum) and 17 days (harvest site) after surgery. The incidence of deep sternal infections was 1.1 %. Our analysis did not suggest any specific risk factors. Incidence did not significantly increase with higher NNIS risk index; however, 95% of the patients fell into the same risk category.

Conclusions: We have provided a baseline rate for SSIs after CABG procedures in Norway. The results show the importance of post-hospital discharge follow-up. The NNIS risk index did not adequately stratify CABG patients. We recommend that more potential risk variables should be included in the surveillance, for example EuroSCORE.