Analysis Of Risk Factors Of Healthcare-associated Infection And Evaluation Of Economic Burden In Patients Undergoing CABG

ObjectivesThe study aimed to analyze the current conditions of healthcare-associated infection(HAI)on patients who undergoing coronary artery bypass grafting surgeries and to investigate the independent risk factors on HAI in order to provide evidence on effective preventive and control measures on HAI for hospital and staffs.The direct and indirect economic burden caused by HAI for the target population were also evaluated and we hope to provide regulatory and administrative departments with evidence on means to reduce waste on medical resources.MethodsPredicative analysis was applied on a total of 538 qualified patients admitted in cardiac surgical department in a tertiary hospital from January 1st,2017 to December 31st,2018 over the period of two years.The data collected was filled in the self-designed questionnaires:?Questionnaire on healthcare-associated infection in patients undergoing coronary artery bypass grafting surgery?and?Questionnaire on the economic burden of healthcare-associated infection in patients undergoing coronary artery bypass grafting surgery?(1)Risk factor analysis:SPSS 23.0 was used for statistical analysis,means,standard deviation,median,ratio and percentage were used to describe the gathered information,and the difference between groups were evaluated using the t test,Mann-Whitney U test,Chi-square test and Fisher exact probability,while applying univariate and multiple logistic regressions.(2)Economic burden evaluation:the infected group and control group were matched using the propensity score matching(PSM)based on patient records.Wilcoxon rank sum test was applied to contrast the hospitalized duration and cost from the two groups,which was then used to estimate the direct economic burden from this infection.Indirect burden was estimated based on the absence from work for the patient and one family member.Results1.A total of 538 coronary bypass grafting surgery cases who meet the matched the enrollment criteria were used in the study,out of which 400(74.35%)were male and 138(25.65%)were female.The mean age was 62.43±8.09 years old.Simple coronarsy artery bypass grafting was performed in 522 patients,accounting for 97.00%:;16 patients underwent combined other operations,accounting for 3.00%.2.A total of 143 cases(162 episodes)were identified with the incidence of healthcare-associated infection reaching 26.58%.and the incidence of healthcare-associated infection cases was 30.11%.Lower respiratory infection was the most common healthcare-associated infection site with 132 cases(composition ratio 24.54%),followed by superficial chest incision infection with 12 cases,accounting for 2.23%;deep chest incision infection with 7 cases(composition ratio 1.30%)and urinary tract infection(UTI)with 6 cases(composition ratio 1.12%).3.The 9 independent risk factors among patients undergoing coronary bypass grafting surgeries were analyzed using multiple logistic regression are as follows:Euroscore,length of stay,preoperative preparation time,postoperative blood transfusion volume,use of non-invasive ventilator and usage days,duration of surgery,duration of urinary catheter and thoracic drainage tube indwelling.4.The median of hospitalization total cost for the infected group is 148111.11 yuan,while the median of hospitalization total cost for the control group is 111228.86 yuan,leading to a difference of 36882.25 yuan.The most significant cost difference is 12038.10 yuan and 14770.07 yuan which is caused by western medicine and the health materials.HAI caused an increase of 5 days in hospitalized stay.The indirect economic burden for a patient with HAI is 1865.00 yuan and the total economic burden is 38747.25 yuan.ConclusionsThe risk for HAI is higher for patients undergoing coronary artery bypass grafting surgeries due to the high level of traumatic and invasive procedures involved in post-op.The HAI rate in this study is 26.58%which is relatively similar with other domestic studies.The independent risk factors for HAI found in this study are:Euroscore,length of stay,preoperative preparation time,postoperative blood transfusion volume,use of non-invasive ventilator and usage days,duration of surgery,duration of urinary catheter and thoracic drainage tube indwelling.HAI is the direct cause for increase in direct economic burden and prolonged length of stay,which lead to an increase in indirect economic burden as well.Depending on the different infected site,the economic burden varies as well.Clinical staff should consider the factors mentioned above to improve protocols and reduce the occurrence of post-op HAIs and the economic burden in patients undergoing CABG.