# Association of Obesity and Prolonged Hospital Stay With Surgical Site Infections After Coronary Artery Bypass Grafting in Intermediate- to High-Risk Patients: Insights From a Single-Center Study

## TL;DR

Obesity and longer hospital stays are linked to higher infection rates after heart surgery in high-risk patients.

## Contribution

Identifies obesity and prolonged hospital stay as significant risk factors for surgical site infections after CABG in intermediate- to high-risk patients.

## Key findings

- 33% of patients developed surgical site infections after CABG.
- Obesity and prolonged hospital stay were significantly associated with higher infection rates.
- Age, gender, smoking, diabetes, and ejection fraction were not significantly linked to infections.

## Abstract

Coronary artery bypass grafting (CABG) is one of the most common surgical procedures, contributing to improved long-term survival and quality of life for patients with coronary artery disease (CAD). However, surgical site infections (SSIs) remain a serious complication, increasing mortality, morbidity, and hospital length of stay.

Background/objectives: The study aimed to determine the incidence of SSIs and to identify factors associated with their development in patients at intermediate- to high-risk of infection undergoing CABG. It also aimed to provide context-specific evidence to inform targeted preventive strategies.

Methods: The study included 51 patients (39 (76.5%) men, 12 (23.5%) women; mean age 67.2 ± eight years) who underwent CABG via median sternotomy. Patients were preoperatively stratified for SSI risk using the Brompton Harefield Infection Score (BHIS), and only those classified as intermediate or high risk were included. The occurrence of SSIs was evaluated postoperatively using the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay as inpatient prolonged over 14 days (ASEPSIS) scoring system. Data were analyzed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA).

Results: Infections were observed in 17 (33%) patients. The occurrence of SSIs was positively associated with prolonged hospital stay (ρ = 0.512, p < 0.001) and obesity (f = 0.348, p = 0.013). Age, gender, smoking, diabetes mellitus, and ejection fraction were not statistically significantly associated with infection occurrence.

Conclusions: Obesity and prolonged hospital stay were significantly associated with higher SSI rates in patients after CABG. The high incidence of SSIs highlights the urgent need for targeted interventions in patients at increased risk. Early identification and proactive management of patients at increased risk may help reduce infection rates, improving postoperative outcomes and patient quality of life. The small sample size of this study, the data collection from a single cardiothoracic surgery center, and the limited number of examined variables are limitations that indicate the need for further research.