Risk factors for sternal and leg surgical site infections after cardiac surgery in Taiwan.

To account for time factors related to hospitalization, the authors calculated incidence rates of surgical site infection (SSI) instead of cumulative incidence and assessed risk factors for SSI after cardiac surgery. From July 1999 to August 2000, all cardiac surgery patients in the Taipei Veterans General Hospital (Taipei, Taiwan) were invited to join the study. Data were collected by chart review, including information on patient characteristics and potential risk factors at the preoperative, intraoperative, and postoperative stages. The authors employed multiple logistic regression analyses using a generalized logit model to assess associations of interest. SSI incidence rates were 2.5 episodes per 1,000 person-days for the sternum and 3.6 episodes per 1,000 person-days for the leg. After adjustment for covariates, age (in years), gender (female vs. male), New York Heart Association classification (moderate/severe vs. normal/mild), creatinine concentration (mg/dl), and duration of surgery (in minutes) were significantly associated with sternal SSI, while age, peripheral arterial occlusive disease, and length of stay in the intensive care unit (in hours) were significantly associated with leg SSI. In addition to patients' characteristics and health situations, the significant findings for duration of surgery and length of intensive care unit stay indicate that the incidence rate is more appropriate than cumulative incidence for studying risk factors for SSI.

Effects of phase I cardiac rehabilitation on anxiety of patients hospitalized for coronary artery bypass graft in Taiwan.

OBJECTIVE: To assess the effects of phase I cardiac rehabilitation intervention on anxiety of patients hospitalized for coronary artery bypass graft (CABG) surgery. DESIGN: Prospective, quasi-experimental, random assignment, repeated measurements. SETTING: The Veterans General Hospital Taipei, Taiwan, Republic of China. PATIENTS: Seventy patients were randomly assigned to (1) the phase I cardiac rehabilitation intervention (experimental) group and (2) the nonintervention (comparison) group. Ultimately, 60 subjects were included in the data analyses. OUTCOME MEASURES: Psychological status was evaluated by the state of anxiety scores on the State-Trait Anxiety Inventory. Anxiety scores were measured 3 times: (1) after admission, before the patient underwent CABG surgery; (2) the day before the patient underwent CABG surgery; and (3) the day of discharge from the hospital. INTERVENTION: Individual instruction in progressive exercises and daily activities according to the phase I cardiac rehabilitation program (Chinese manual) were used during hospitalization. RESULTS: Data analysis was performed with use of generalized estimating equations (GEE) to assess the between- and within-group variations. The mean anxiety for all subjects before undergoing CABG surgery was 42.6. The mean anxiety on the day before undergoing CABG surgery was 33.7 in the experimental group and 49.8 in the comparison group; there were statistical differences, with a P <.05 level of significance between these 2 groups. The mean anxiety on the day of discharge in the experimental group was 28.6 and in the comparison group was 38.4; there were statistical differences, with a P <.05 level of significance between these 2 groups. CONCLUSIONS: These results have been supported by similar studies. This finding suggests that application of phase I cardiac rehabilitation intervention can reduce the anxiety level during hospitalization of patients undergoing CABG surgery.