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Management Practices and the Risk of Infection Following Cardiac Surgery

4. april 2014 opdateret af: Icahn School of Medicine at Mount Sinai
The purpose of the study is to determine the best ways to prevent infections after heart surgery. Participation in the study will last at most 3 months after heart surgery. The study will only collect information about the care patients receive during the planned surgery. No new testing or procedures will be done. Patients will receive only the tests or procedures the doctor already has planned. This kind of study is an observational study, because all that is planned to do is observe the care patients receive and how well they do during treatment. The information collected should help to improve the quality of surgical care in the future.

Studieoversigt

Status

Afsluttet

Betingelser

Detaljeret beskrivelse

Hospital-acquired infections represent the main non-cardiac complication after heart surgery. They are associated with substantial morbidity and higher mortality, as they often require prolonged hospitalization and additional surgery. The proportion of cardiac surgery patients at high-risk for infection is increasing because of the increased prevalence of co-morbid conditions such as obesity and diabetes mellitus in the general (and especially the elderly) population.

In addition to increased morbidity and mortality, infectious complications also result in greater economic burden. A past study estimated that the incremental cost of treating Medicare beneficiaries who suffered from septicemia after coronary artery bypass grafting (CABG) to be $59,204. These patients stayed in the hospital 21.3 days longer than those who did not experience any serious adverse events. Of great relevance to treating hospitals, the Centers for Medicare and Medicaid Services (CMS) announced in the fall of 2007 that they would no longer pay for care related to preventable complications. CMS specifically mentioned excluding reimbursements for mediastinitis after CABG, and catheter associated infections. Thus, there is a crucial need to identify variables that mitigate infections post cardiac surgery and to develop effective preventative treatment strategies.

Prior studies have examined the relationship between patient baseline (preoperative) characteristics (e.g., co-morbid conditions) and hospital-acquired infections post cardiac surgery. The STS database, for example, has led to the identification of predictive factors of post-operative CABG infections. Much of the variations in outcomes seen at different institutions, however, cannot be explained by differences in preoperative patient characteristics alone. How care is delivered also plays an essential role in determining infection rates and is therefore likely to explain some of the differences in these rates observed at different institutions. The literature has not sufficiently examined the relationship between treatment/management practices (e.g., line management, ventilator management, etc) and postoperative infection risk. In this study we seek to better understand management practices that put patients at high risk for infections post-cardiac surgery.

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

5158

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Canada
    • Quebec
      • Montreal, Quebec, Canada, H1T 1C8
        • Montreal Heart Institute
  • Forenede Stater
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30383
        • Emory University
    • Maryland
      • Bethesda, Maryland, Forenede Stater, 20892
        • NIH Heart Center at Suburban Hospital
    • New York
      • Bronx, New York, Forenede Stater, 10467
        • Montefiore Einstein Heart Center
      • New York, New York, Forenede Stater, 10032
        • Columbia University Medical Center
    • North Carolina
      • Durham, North Carolina, Forenede Stater, 27710
        • Duke University
      • Greenville, North Carolina, Forenede Stater, 27834
        • East Carolina Heart Institute
    • Ohio
      • Cleveland, Ohio, Forenede Stater, 44195
        • Cleveland Clinic Foundation
    • Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • University of Pennsylvania
    • Virginia
      • Charlottesville, Virginia, Forenede Stater, 22908
        • University of Virginia

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

All patients undergoing cardiac surgical interventions at the 10 CT Surgery Network institutions

Beskrivelse

Inclusion Criteria:

  • Clinical indication for cardiac surgical interventions
  • Age ≥ 18 years

Exclusion Criteria:

  • Active systemic infection at the time of enrollment

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Patients undergoing cardiac surgery
The patient population for this study consists of all patients undergoing cardiac surgical interventions. All patients who meet the eligibility criteria may be included in the study regardless of gender, race or ethnicity.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
The primary endpoint will be major infection within 60 days of index cardiac surgical intervention.
Tidsramme: 60 Days
60 Days

Sekundære resultatmål

Resultatmål
Tidsramme
Major infection after surgery during the operative admission or within 30 days after discharge when associated with readmission.
Tidsramme: 30 Days
30 Days
Other infections within 60 days of index cardiac surgical intervention; Superficial incisional surgical site infection (primary/secondary); Symptomatic urinary tract infection; Asymptomatic bacteriuria
Tidsramme: 60 Days
60 Days
Non-infection adverse events within 60 days of index cardiac surgical intervention; Neurologic Dysfunction; Transient ischemic attack; cerebrovascular accident (ischemic or hemorrhagic stroke); Myocardial infarction
Tidsramme: 60 Days
60 Days
Re-operation within 60 days of index cardiac surgical intervention
Tidsramme: 60 Days
60 Days
Survival, All-cause mortality, Hospitalizations, Economic Measures
Tidsramme: 60 Days
60 Days

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Icahn School of Medicine at Mount Sinai

Samarbejdspartnere

National Heart, Lung, and Blood Institute (NHLBI)
Canadian Institutes of Health Research (CIHR)
National Institute of Neurological Disorders and Stroke (NINDS)

Efterforskere

  • Studiestol: Timothy Gardner, MD, Christiana Care Health Services
  • Studiestol: Patrick O'Gara, MD, Brigham and Women's Hospital
  • Ledende efterforsker: Annetine Gelijns, Ph.D., Icahn School of Medicine at Mount Sinai

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Hjælpsomme links

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. januar 2010

Primær færdiggørelse (Faktiske)

1. september 2011

Studieafslutning (Faktiske)

1. marts 2013

Datoer for studieregistrering

Først indsendt

17. marts 2010

Først indsendt, der opfyldte QC-kriterier

17. marts 2010

Først opslået (Skøn)

18. marts 2010

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

8. april 2014

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

4. april 2014

Sidst verificeret

1. april 2014

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • GCO 08-1078-00005
  • 5U01HL088942 (U.S. NIH-bevilling/kontrakt)
  • 5U1HL088942-02
  • 694 (Anden identifikator: Ct Surgery Network Research Group)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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