Heart surgeries are complex procedures that carry several risks, including pneumonia, which is the most common infection patients might face after such operations.
Dr. Francis Pagani, a cardiac surgeon at the University of Michigan Health Frankel Cardiovascular Center, emphasizes that pneumonia is a major concern following any surgery, particularly after cardiac operations due to their complexity.
In an effort to improve patient care, a research team led by Dr. Donald Likosky set out to identify factors that could increase the risk of developing pneumonia post-surgery.
The study, which spanned from 2011 to 2021 and involved over 70,000 patients across 33 institutions, was supported by Blue Cross Blue Shield of Michigan and the Agency for Healthcare Research and Quality.
The findings, published in The Journal of Thoracic and Cardiovascular Surgery, identified nine critical factors that significantly impact the risk of pneumonia. These factors ranged from procedural to post-operative practices.
One of the key findings was the duration a patient remains intubated with a breathing tube after surgery. The research indicated that leaving the breathing tube in for more than six hours post-operation increases the risk of developing an infection.
Noah Barnett, a third-year medical student and first author of the study, highlighted this as a major risk factor.
Another significant factor is the use of an intra-aortic balloon pump. This device is inserted into a major artery and is used to stabilize patients at high risk of heart failure by helping maintain blood pressure. However, its use can also increase the likelihood of developing pneumonia.
The study also noted that patients who were on cardiopulmonary bypass for over 90 minutes or received intraoperative blood transfusions faced higher risks of pneumonia.
Interestingly, undergoing a surgical aortic valve replacement was associated with a reduced risk compared to coronary artery bypass grafting.
The use of a transesophageal echocardiogram during surgery, while crucial for assessing the heart’s function, was also linked to a higher risk of infection. This procedure involves inserting an ultrasound device down the esophagus to get detailed images of the heart.
Additionally, the study found that body temperature regulation during surgery plays a role. Lower blood temperatures during operations, which reduce metabolic demand and protect the brain and other organs, were associated with lower pneumonia rates.
Revascularization, or the process of bypassing blocked coronary arteries to restore blood flow to heart muscle, also correlated with a lower risk of pneumonia. This process helps to ensure that more of the heart muscle receives adequate blood flow and oxygen.
Dr. Pagani advises patients to actively participate in their recovery to minimize pneumonia risks. This includes engaging in prescribed breathing exercises and using medical devices like incentive spirometers, which encourage deep breathing to increase lung capacity.
Walking and other mild physical activities as recommended by the healthcare team can also help in reducing the risk of postoperative pneumonia.
Overall, the study underscores the importance of understanding various factors that can influence the occurrence of pneumonia after heart surgery, thereby helping healthcare providers better manage these risks.
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The research findings can be found in The Journal of Thoracic and Cardiovascular Surgery.
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