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Cardiac Surgery and Steroids: Unveiling the Risks of Surgical Site Infections

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Kai Mendoza in Health & Wellness October 2026 • 5 min read.

"A deep dive into the factors that increase the likelihood of postoperative infections, helping patients and healthcare providers stay informed and proactive."


Undergoing cardiac surgery is a significant health event, and while it can be life-saving, it's crucial to be aware of potential complications. Postoperative infections, especially surgical site infections (SSIs), are a major concern. These infections can lead to increased morbidity, mortality, and healthcare costs. Identifying risk factors associated with these infections is essential for targeted prevention strategies.

A comprehensive study, 'Steroids in Cardiac Surgery Trial: A Substudy of Surgical Site Infections,' delved into these risk factors using data from a large, multi-center randomized controlled trial. The original trial, known as SIRS (Steroids in Cardiac Surgery), investigated the effects of intraoperative methylprednisolone (a steroid) administration during cardiac surgery. While the initial trial found no impact on mortality or major morbidity from steroid use, this substudy focused specifically on identifying risk factors for SSIs.

This analysis provides valuable insights that empower both patients and healthcare providers. Understanding these risks allows for better preparation, preventative measures, and ultimately, improved outcomes after cardiac surgery.

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Preventing Infection in Cardiac Surgery

Surgical site infections (SSIs) are a major concern in cardiac surgery because they are associated with increased morbidity and healthcare costs, and cardiac procedures carry a particularly high risk of infection (Reference URL 1; Reference URL 2). One review reports postoperative infection risks ranging from 3.5% to 26.8%, and identifies mediastinitis as a serious concern after open cardiac surgery . Infection prevention calls for a multidisciplinary approach, beginning with preoperative risk-factor modification and continuing through postoperative intensive care .

What Factors Increase Your Risk of Surgical Site Infections After Cardiac Surgery?

Heart surgery with protective barrier

The study analyzed data from 7,406 patients who underwent cardiac surgery, excluding those who died intraoperatively or within 48 hours post-operation. Researchers tracked the occurrence of surgical site infections within the first 30 days after surgery and employed a statistical model to pinpoint significant risk factors. Here’s what they discovered:

Several factors significantly increased the risk of developing a surgical site infection:

  • Diabetes Managed with Insulin: Patients whose diabetes was managed with insulin had a higher risk (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI]: 1.13 to 2.12).
  • Oral Hypoglycemics or Diet-Controlled Diabetes: Similar risks were observed for those managing diabetes with oral medications (aOR 1.60; 95% CI 1.18 to 2.16) or diet alone (aOR 1.81; 95% CI 1.16 to 2.83).
  • Female Sex: Being female was associated with an increased risk (aOR 1.34; 95% CI 1.05 to 1.71).
  • Renal Failure: Both with (aOR 2.03; 95% CI 1.06 to 3.91) and without dialysis (aOR 1.50; 95% CI 1.04 to 2.14), renal failure increased infection risk.
  • Prolonged Cardiopulmonary Bypass (CPB) Time: Surgeries requiring longer CPB times (over 96 minutes) elevated risk (aOR 1.84; 95% CI 1.44 to 2.35).
  • Body Mass Index (BMI): Both underweight (BMI < 22.3, aOR 0.44; 95% CI 0.28 to 0.71) and obese (BMI > 30, aOR 1.49; 95% CI 1.17 to 1.89) individuals faced heightened risk.
  • Elevated Blood Glucose Levels: Higher peak blood glucose levels in the intensive care unit (ICU) were also a factor (aOR 1.02 per mmol·L¯¹; 95% CI 1.00 to 1.04).
  • Coronary Artery Bypass Grafting (CABG): Undergoing CABG was riskier than other types of cardiac surgeries (aOR 2.59; 95% CI 1.87 to 3.59).
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Recent Evidence and Risk Factors

A systematic review of steroids in cardiac surgery reports that prior research found no correlation between steroid use and SSIs, while noting that this finding was not consistent with the Whitlock study doi.org. An integrative review links postoperative infection susceptibility to hemodynamic compromise and the scale of the intervention, which can involve stronger systemic inflammatory responses and hemodynamic and immunological alterations doi.org. A 2025 study describes its aim as determining the incidence, characteristics, and associated risk factors of nosocomial infections in adult cardiac surgery patients and developing a nomogram prediction model .

A Broad Range of Infection Rates

A 2022 review describes SSIs as significant complications associated with poorer prognosis and notes that cardiac surgical procedures carry a particularly high risk of postoperative infection mdpi.com. It reports infection incidence rates ranging from 3.5% to 26.8% among cardiac surgery patients. The range underscores that reported infection incidence varies across the evidence summarized by the review; the source does not attribute that variation to steroid use.

Consequences for Recovery and Quality of Life

A report on SSIs after cardiac surgery associates these infections with poorer prognosis and increased morbidity and mortality scirp.org. It also describes postoperative quality-of-life deterioration, prolonged recovery, and longer hospital stays. These reported outcomes show that the impact extends beyond the infection itself to patients’ recovery and time in hospital.

Interestingly, the study also found that being underweight (BMI less than 22.3) also increased the risk of surgical site infections. This highlights the importance of maintaining a healthy weight, whether that means gaining or losing weight, to optimize surgical outcomes.

Taking Steps to Minimize Your Risk

While some risk factors, like sex and the type of surgery needed, are unavoidable, many others can be managed through proactive measures. By understanding these risks and working closely with your healthcare team, you can significantly reduce your chances of developing a surgical site infection and improve your overall recovery after cardiac surgery. Make sure to have open and honest conversations with your doctor about your individual risk factors and the best strategies for managing them.

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The Scale of the Infection Risk

A 2022 review characterizes SSIs as significant complications associated with poorer prognosis and says cardiac surgical procedures carry a particularly high risk of postoperative infection pubmed.ncbi.nlm.nih.gov. It reports incidence rates ranging from 3.5% to 26.8% in cardiac surgery patients. The wide reported range emphasizes the scale of the concern while preserving the review’s uncertainty about a single incidence figure.

Patient Outcomes After Infection

A multicenter study focused on mortality risk factors associated with SSIs after heart surgery, describing these infections as increasing morbidity and mortality rates pmc.ncbi.nlm.nih.gov. Its stated focus highlights the serious potential consequences for patients following cardiac surgery. The source snippet does not provide specific mortality figures or name the risk factors identified.

What related cardiac-surgery reports add

A later systematic review said earlier research generally found no correlation between steroid use and surgical site infections, while noting that this did not match the Whitlock study’s result. That contrast means the summarized evidence does not point to a single consistent conclusion about steroids and infection risk.[1]

What the reports leave unresolved

  • How do infection rates compare between steroid and placebo groups when each group’s total enrollment and comparable follow-up are taken into account? The cited infection counts are not accompanied here by those denominators.[1]
  • Why did the systematic review describe prior findings as inconsistent with the Whitlock study, and which differences between the underlying comparisons might explain that disagreement?[1]
  • How much do factors such as smoking, lung disease, age, illness severity, transfusion volume, insulin needs, and recent H2-receptor-antagonist use contribute independently to infection risk? The cited review lists correlations, but the excerpt does not quantify their separate effects.[1]

Terms used in the infection reports

H2 receptor antagonist
A medication class whose use within a week before surgery was listed as correlated with infections.[1]

Sources

  1. STEROIDS IN CARDIAC SURGERY: A SYSTEMATIC REVIEW (2023)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s12630-018-1253-5, Alternate LINK

Title: Steroids In Cardiac Surgery Trial: A Substudy Of Surgical Site Infections

Subject: Anesthesiology and Pain Medicine

Journal: Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Publisher: Springer Science and Business Media LLC

Authors: Graham R. Mcclure, Emilie P. Belley-Cote, John Harlock, Andre Lamy, Michael Stacey, P. J. Devereaux, Richard P. Whitlock

Published: 2018-12-10

Everything You Need To Know

1

What are the primary risk factors for surgical site infections (SSIs) identified in the Steroids in Cardiac Surgery Trial Substudy following cardiac surgery?

The 'Steroids in Cardiac Surgery Trial: A Substudy of Surgical Site Infections' identified several factors that increase the risk of Surgical Site Infections (SSIs) after cardiac surgery. These include diabetes managed with insulin, oral hypoglycemics, or diet; being female; renal failure (with or without dialysis); prolonged cardiopulmonary bypass (CPB) time; being underweight or obese based on Body Mass Index (BMI); elevated blood glucose levels in the ICU; and undergoing coronary artery bypass grafting (CABG). These risk factors were determined through the analysis of data from over 7,400 patients, highlighting the significance of each factor in postoperative infection rates.

2

How does the management of diabetes (with insulin, oral hypoglycemics, or diet) impact the risk of surgical site infections (SSIs) after cardiac surgery, according to the Steroids in Cardiac Surgery Trial Substudy?

The Steroids in Cardiac Surgery Trial Substudy indicates that individuals with diabetes, regardless of whether it's managed through insulin, oral medications, or diet alone, face a higher risk of surgical site infections (SSIs) following cardiac surgery. The adjusted odds ratios (aORs) for each management method are significant, suggesting that the underlying metabolic conditions associated with diabetes—such as impaired immune function and wound healing—contribute to this increased risk. While the study identifies this correlation, it does not explore specific interventions beyond general risk management. Further research could investigate targeted glycemic control strategies to mitigate SSI risk in diabetic patients undergoing cardiac surgery.

3

Why are both underweight and obese individuals at a higher risk of developing surgical site infections (SSIs) following cardiac surgery, as indicated by the Steroids in Cardiac Surgery Trial Substudy?

The Steroids in Cardiac Surgery Trial Substudy found that both underweight (BMI < 22.3) and obese (BMI > 30) individuals are at increased risk of Surgical Site Infections (SSIs) after cardiac surgery. While obesity's link to SSIs is often attributed to factors like increased subcutaneous fat and impaired blood supply, the increased risk in underweight individuals may relate to compromised immune function and nutritional deficiencies. This finding underscores the importance of optimizing nutritional status before cardiac surgery, whether through weight gain or weight loss, to mitigate infection risks. Further research could explore specific nutritional interventions to improve surgical outcomes for patients at both ends of the BMI spectrum.

4

How does prolonged cardiopulmonary bypass (CPB) time during cardiac surgery influence the likelihood of surgical site infections (SSIs), based on the findings from the Steroids in Cardiac Surgery Trial Substudy?

The Steroids in Cardiac Surgery Trial Substudy found that surgeries requiring longer Cardiopulmonary Bypass (CPB) times (over 96 minutes) are associated with an elevated risk of Surgical Site Infections (SSIs). Prolonged CPB can lead to increased inflammation, immunosuppression, and tissue damage, creating an environment more conducive to infection. While the study identifies CPB duration as a risk factor, it doesn't delve into specific strategies to mitigate this risk. Future studies could explore interventions such as modified CPB techniques or pharmacological agents to reduce inflammation and improve immune function during prolonged surgeries, potentially lowering SSI rates.

5

What specific characteristics of Coronary Artery Bypass Grafting (CABG) might contribute to a higher risk of surgical site infections (SSIs) compared to other cardiac surgeries, as suggested by the Steroids in Cardiac Surgery Trial Substudy?

The Steroids in Cardiac Surgery Trial Substudy identifies undergoing Coronary Artery Bypass Grafting (CABG) as a risk factor for Surgical Site Infections (SSIs) compared to other types of cardiac surgeries. The higher risk associated with CABG could be related to the complexity and duration of the procedure, the extent of tissue trauma, and the potential for more extensive wound sites, all of which can increase susceptibility to infection. While the study highlights this association, it doesn't explore specific differences in surgical techniques or patient characteristics that might explain the increased risk. Further research could investigate these factors to identify targeted strategies for reducing SSI rates in CABG procedures.

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