Evidence map›Paper›PMID 39800274›Full record

ArticleThe Journal of thoracic and cardiovascular surgery2025

Interhospital variability in 180-day infections following cardiac surgery.

Syed Sikandar Raza, Shiwei Zhou, Noah M Barnett, Chiang-Hua Chang, Robert B Hawkins, Raed Alnajjar, Alphonse DeLucia, Charles F Schwartz, Michael P Thompson, Thomas M Braun and 5 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of thoracic and cardiovascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Syed Sikandar RazaDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Shiwei ZhouDivision of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Mich.
Noah M BarnettUniversity of Michigan Medical School, Ann Arbor, Mich.
Chiang-Hua ChangDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Robert B HawkinsDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Raed AlnajjarDepartment of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Mich.
Alphonse DeLuciaDepartment of Cardiac Surgery, University of Michigan Health-West, Wyoming, Mich.
Charles F SchwartzDivision of Cardiothoracic Surgery, Department of Surgery, Trinity Oakland Hospital, Pontiac, Mich.
Michael P ThompsonDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Michigan Value Collaborative, Ann Arbor, Mich.
Thomas M BraunDepartment of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Mich.
Eric N HammondDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
Jeremy WolvertonDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Francis D PaganiDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
Donald S LikoskyDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich. Electronic address: likosky@med.umich.edu.
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and the Michigan Value Collaborative

Funding

AHRQ HHS R01 HS029026
6 · The paper itself

Abstract

objectiveTo evaluate hospital-level variation in infections following cardiac surgery and develop and evaluate a 180-day infection quality metric.

methodsThis study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was infection occurring within 180 days of surgery. Adjusted institutional infection rates were estimated using logistic regression with robust variance estimation. Terciles of observed/expected ratios were created to assess interhospital variability in infections and associated morbidity and mortality.

resultsA total of 5466 operations were evaluated. The average patient age was 71.1 ± 7.8 years, 29.5% of the patients were female, and 4.8% were black. The infection rate was 21.2% overall and higher among females. Infection was associated with lower left ventricular ejection fraction, diabetes, severe chronic lung disease, cerebrovascular disease, and urgent operations (P < .0001 for all). The most common infection was pneumonia (8.5%). Adjusted infection rates varied 39.5% across hospitals (range, 7.2%-46.7%). Patients treated in hospitals in the highest tercile of observed/expected infection ratio had a higher rate of associated discharge to extended care/rehabilitation (27.9% vs 24.7%, P < .0001) but comparable stroke and mortality risk compared to patients treated in hospitals in the lowest tercile.

conclusionsOne in 5 Medicare beneficiaries develop a 180-day infection following cardiac surgery, with rates varying 39.5% across hospitals. Patients at higher versus lower O:E tercile hospitals were more commonly discharged to extended care/rehabilitation settings, although rates of stroke and mortality were equivalent in the 2 groups. Collaborative learning interventions may be warranted to advance the observed variability in 180-day infections.

Indexed as

Cardiac Surgical ProceduresCross InfectionHealthcare DisparitiesSurgical Wound InfectionAgedAged, 80 and overDatabases, FactualFemaleHumansMaleMedicareMichiganMiddle AgedQuality Indicators, Health CareRisk FactorsTime Factorscardiac surgeryinfectionsoutcomes

Identifiers

PMID39800274
PMCPMC12961589

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.