The COVID-19 pandemic and reduced surgical site infection following cardiac surgery: time to take up the baton

Abstract

Abstract Background Various hygienic measures have been reinforced or newly-adopted since the start of the COVID-19 pandemic. At the same time, studies have indicated a reduction in various types of hospital-acquired infections, including surgical site infections (SSI). Purpose This study investigated the association of the pandemic with SSI following cardiac surgeries. Method From 2014 to 2022, 26143 patients undergoing cardiac surgery were included and categorized into "pre-pandemic" (n= 22015) and "during-pandemic" (n=4128) groups. SSIs were classified into harvest-site, superficial sternal, and complex sternal infection. Logistic regression (univariate and multivariable) and inverse probability weighting (IPW) assessed the association of the pandemic with SSIs. For both analyses, various known SSI-related risk factors were taken into account as covariates. Results Among the study population, 793 SSIs occurred. The "during-pandemic" patients were significantly younger (61.87±10.58 vs. 65.64 ±11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of comorbidities/risk factors (expect for cigarette smoking). Total SSI rate significantly plummeted from 3.3% before COVID-19 to 1.8% afterward (P<0.001) (Figure 1 and 2). IPW analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted-OR: 0.59, 95% confidence interval (CI):0.45-0.78), harvest-site (adjusted-OR: 0.36, 95%CI: 0.19-0.70), and superficial sternal infection (adjusted-OR: 0.60, 95%CI: 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted-OR: 1.05, 95% CI: 0.55-2.01). Multivariable regression recapitulated these findings (Figure 2). Conclusions The COVID-19 pandemic pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. To some extent, the drop in SSIs following the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending reinforcement of and adherence to these measurements into the post-COVID-19 era to maintain the status quo.