Table 5.
Management Practices and Unadjusted Risk Ratios (Major Infection)
| Variable | No. (%) | Infection Rate | Unadjusted HR* | 95% CI |
|---|---|---|---|---|
| Nasal decontamination (yes/no) | 2427 (47.1) | 0.023 | 0.80 | 0.61–1.03 |
| Hair removal (Males only) | ||||
| Shaving | 108 (3.1) | 0.013 | 0.60 | 0.19–1.87 |
| Clipping, depilatory cream, no hair removal | 3342 (96.9) | 0.028 | 1.00 (ref) | |
| Scrubbing surgical site | ||||
| Chlorhexidine preparations | 4148 (81.6) | 0.029 | 1.36 | 0.94–1.97 |
| Iodophors, alcohol, soap and water, other | 933 (18.4) | 0.021 | 1.00 (ref) | |
| Central lines | ||||
| More than 1§ (vs. ≤1 line) | 542 (10.5) | 0.051 | 2.06 | 1.49–2.85 |
| Femoral§ (vs. no femoral line) | 37 (0.72) | 0.166 | 5.63 | 2.78–11.39 |
| Appropriate timing of preoperative antibiotics† (yes/no) | 4422 (86.4) | 0.028 | 0.97 | 0.67–1.40 |
| Intraoperative antibiotic re-dosed after 6 hrs (yes/no) | 5034 (97.6) | 0.026 | 0.41 | 0.23–0.71 |
| Type of perioperative antibiotics | ||||
| 2nd generation cephalosporins | 2405 (46.6) | 0.020 | 0.64 | 0.49–0.83 |
| 1st generation cephalosporins, vancomycin, other | 2753 (53.4) | 0.034 | 1.00 (ref) | |
| Postoperative antibiotic duration§ | ||||
| 0–24 hours | 2599 (50.4) | 0.020 | 1.14 | 0.83–1.55 |
| 24–48 hours | 2126 (41.2) | 0.020 | 1.00 (ref) | |
| >48 hours | 433 (8.4) | 0.113 | 5.90 | 4.25–8.19 |
| Packed Red Blood Cells, unit (median, IQR)‡ | 3 (2, 5) | 0.043 | 1.29 | 1.24–1.33 |
| Venue of urinary catheter insertion | ||||
| Bedside/Other hospital | 65 (1.3) | 0.089 | 1.00 (ref) | |
| Operating room | 5075 (98.7) | 0.027 | 0.28 | 0.15–0.52 |
| Nasogastric tube used (yes/no) | 3749 (72.7) | 0.023 | 1.20 | 0.89–1.62 |
| Glucose management (1st 48 hours after surgery) § | ||||
| Hyperglycemic episode (>180 mg/dl) | 2228 (43.3) | 0.037 | 1.78 | 1.35–2.33 |
| No Hyperglycemic episode (≤180 mg/dl) | 2923 (56.8) | 0.020 | 1.00 (ref) | |
| Mechanical ventilation§ | ||||
| ≤ 24 hours | 4084 (79.2) | 0.015 | 1.00 (ref) | |
| 24–48 hours | 683 (13.3) | 0.049 | 2.69 | 1.92–3.76 |
| > 48 hours | 387 (7.5) | 0.117 | 7.74 | 5.77–10.39 |
| Elevation of head of bed (yes/no) | 5139 (99.7) | 0.027 | 0.35 | 0.09–1.42 |
| Routine aspiration of secretions (yes/no) | 4955 (96.1) | 0.028 | 3.21 | 1.03–10.02 |
Abbreviations: CI, confidence interval; HR, hazard ratio; IQR, interquartile range.
*
HR for glucose management adjusted for diabetes
†
Within 1 hour prior to surgical incision (2 hours if receiving vancomycin)
‡
48.1% patients received packed red blood cell transfusion
§
Frequency (%) not accounting for timing of infection:
More than 1 central line: 556 (10.8)
Femoral line: 38 (0.74)
Postoperative Antibiotic Duration: 0–24 hours: 2596 (50.3); 24–48 hours: 2120 (41.1); > 48 hours: 442 (8.6)
Glucose Management: Hyperglycemia: 2229 (43.3); no Hyperglycemia: 2925 (56.8)
Mechanical Ventilation: ≤24 hours: 4067 (78.9); 24–48 hours: 670 (13.0); >48 hours: 417 (8.1)