{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T09:04:45Z","timestamp":1785315885160,"version":"3.55.0"},"reference-count":62,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Despite substantial advances in surgical techniques, anesthesia, and perioperative care, postoperative complications remain a major source of morbidity, mortality, prolonged hospitalization, and healthcare utilization following adult cardiac surgery (CS). Increasing evidence suggests that many of these complications are influenced by modifiable perioperative factors that can be addressed through multidisciplinary care. Materials and Methods: A narrative review was conducted to synthesize current evidence regarding perioperative practices associated with the prevention of postoperative complications in adult CS. A comprehensive literature search of PubMed\/MEDLINE, Scopus, and Web of Science identified studies published between January 2015 and April 2026, supplemented by landmark studies and relevant clinical guidelines. Results: The identified evidence was organized into four major domains: infection prevention practices, physiological optimization strategies, protocol adherence and patient safety measures, and organizational and human factors. The strongest evidence supports timely antimicrobial prophylaxis, standardized infection prevention bundles, perioperative glycemic control, maintenance of normothermia, and patient blood management as key interventions associated with improved postoperative outcomes. Surgical safety checklists, standardized perioperative pathways, and adherence to evidence-based protocols further contributed to improved patient safety and consistency of care. Emerging evidence also highlighted the importance of communication, teamwork, safety culture, workload management, and healthcare professionals\u2019 knowledge in facilitating successful implementation of perioperative interventions. Conclusions: Prevention of postoperative complications following CS requires a multidisciplinary, systems-based approach integrating evidence-based clinical interventions with standardized perioperative protocols and effective organizational practices that facilitate consistent implementation of evidence-based perioperative care. Future research should focus on prospective evaluation of integrated perioperative strategies, development of practical risk-stratification models, and further investigation of organizational determinants influencing implementation and postoperative outcomes.<\/jats:p>","DOI":"10.3390\/medicina62081469","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:16:52Z","timestamp":1785313012000},"page":"1469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Modifiable Perioperative Practices for the Prevention of Postoperative Complications After Cardiac Surgery: A Narrative Review"],"prefix":"10.3390","volume":"62","author":[{"given":"Livia","family":"Ghe\u021ba","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6510-5921","authenticated-orcid":false,"given":"Oana","family":"P\u0103tru","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"V\u00eertosu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Grigorescu","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1658-7526","authenticated-orcid":false,"given":"Lauren\u021biu","family":"Br\u0103escu","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemil","family":"Alsarhan","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3752-2122","authenticated-orcid":false,"given":"Darius","family":"Buriman","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Centre for Translational Research and Systems Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"},{"name":"Department of Functional Sciences, Discipline of Pathophysiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4870-8249","authenticated-orcid":false,"given":"Horea","family":"Feier","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.athoracsur.2023.12.006","article-title":"Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS)","volume":"117","author":"Grant","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","first-page":"769","article-title":"Surgical Site Infection Prevention Bundle in Cardiac Surgery","volume":"112","author":"Siliprandi","year":"2019","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"V\u00eertosu, D.M., Dragomir, A., Cri\u0219an, S., Luca, S., P\u0103tru, O., B\u0103ghin\u0103, R.-M., Laz\u0103r, M.-A., Cozlac, A.-R., Iurciuc, S., and Luca, C.T. (2026). Cumulative Vulnerability in Cardiac Critical Care: A Framework for Understanding Healthcare-Associated Infections and Their Progression to Severe Infection and Sepsis. Medicina, 62.","DOI":"10.3390\/medicina62050908"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"V\u00eertosu, D.-M., Munteanu Dragomir, A., Cri\u0219an, S., Luca, S., P\u0103tru, O., B\u0103ghin\u0103, R.-M., Laz\u0103r, M.-A., Cozlac, A.-R., Iurciuc, S., and Luca, C.-T. (2025). Prevalence of Healthcare-Associated Infections in Patients with Cardiovascular Diseases: A Literature Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144941"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"ezae352","DOI":"10.1093\/ejcts\/ezae352","article-title":"2024 EACTS\/EACTAIC Guidelines on Patient Blood Management in Adult Cardiac Surgery in Collaboration with EBCP","volume":"67","author":"Casselman","year":"2025","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e6903","DOI":"10.1097\/MD.0000000000006903","article-title":"Timing of Preoperative Antibiotic Prophylaxis in 54,552 Patients and the Risk of Surgical Site Infection: A Systematic Review and Meta-Analysis","volume":"96","author":"Gans","year":"2017","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jin, X., Wang, J., Ma, Y., Li, X., An, P., Wang, J., Mao, W., Mu, Y., Chen, Y., and Chen, K. (2020). Association Between Perioperative Glycemic Control Strategy and Mortality in Patients with Diabetes Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.513073"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e011065","DOI":"10.1161\/CIRCOUTCOMES.124.011065","article-title":"Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery","volume":"17","author":"Bauer","year":"2024","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bong, Y.L., Chew, K.S., Sim, S.K., Lee, S.W.F., and Tan, P.C.S. (2025). Perception of Patient Safety Culture among Perioperative Staff: Exploring the Roles of Individual Factors and Organizational Factors. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-025-13531-w"},{"key":"ref_11","first-page":"e60522","article-title":"Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies","volume":"16","author":"Ghanmi","year":"2024","journal-title":"Cureus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/PTS.0000000000001369","article-title":"Putting Patients at Risk: The Effect of Health Care Provider Burnout on Patient Care in the Operating Room-A Narrative Review","volume":"21","author":"Hargreaves","year":"2025","journal-title":"J. Patient Saf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13741-023-00356-6","article-title":"Examining Workload Variations among Different Surgical Team Roles, Specialties, and Techniques: A Multicenter Cross-Sectional Descriptive Study","volume":"13","author":"Totonchilar","year":"2024","journal-title":"Perioper. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Cardiothoracic Interdisciplinary Research Network, Rogers, L.J., Vaja, R., Bleetman, D., Ali, J.M., Rochon, M., Sanders, J., Tanner, J., Lamagni, T.L., and Talukder, S. (2024). Interventions to Prevent Surgical Site Infection in Adults Undergoing Cardiac Surgery. Cochrane Database Syst. Rev., 12, CD013332.","DOI":"10.1002\/14651858.CD013332.pub2"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"zrae143","DOI":"10.1093\/bjsopen\/zrae143","article-title":"Perioperative Patient Safety Recommendations: Systematic Review of Clinical Practice Guidelines","volume":"8","author":"Fabregas","year":"2024","journal-title":"BJS Open"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Qaddumi, J., Abo Hania, S.T.M., Alkhawaldeh, A., ALBashtawy, M., Almagharbeh, W.T., Al-Rshoud, Y.H., Abdalrahim, A., Aljezawi, M., Suliman, M., and Al-Amoush, Z. (2025). Effect of Surgical Site Infection Bundles in Cardiac Surgery: Incidence, Microbiology, and Risk Factors. J. Perioper. Pract., 17504589251377677.","DOI":"10.1177\/17504589251377677"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1213\/ANE.0000000000006286","article-title":"The Society of Thoracic Surgeons\/Society of Cardiovascular Anesthesiologists\/American Society for Extracorporeal Technology Clinical Practice Guidelines for the Prevention of Adult Cardiac Surgery-Associated Acute Kidney Injury","volume":"136","author":"Brown","year":"2023","journal-title":"Anesth. Analg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1177\/0267659121988957","article-title":"Enhanced Recovery after Cardiac Surgery and Its Impact on Outcomes: A Systematic Review","volume":"37","author":"Zhang","year":"2022","journal-title":"Perfusion"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1056\/NEJM199605093341901","article-title":"Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization. Study of Wound Infection and Temperature Group","volume":"334","author":"Kurz","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/j.ajic.2020.01.002","article-title":"Perioperative Body Temperature Maintenance and Occurrence of Surgical Site Infection: A Systematic Review with Meta-Analysis","volume":"48","author":"Poveda","year":"2020","journal-title":"Am. J. Infect. Control"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chen, R., Du, Y., Chen, L., Bai, Y., Zhang, Y., Yu, T., Li, H., and Wang, G. (2025). The Impact of Perioperative Hypothermia on Surgical Site Infection Risk: A Meta-Analysis. BMC Anesthesiol., 25.","DOI":"10.1186\/s12871-025-03277-7"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4626","DOI":"10.1038\/s41598-023-31889-x","article-title":"Hypothermia Is an Independent Risk Factor for Prolonged ICU Stay in Coronary Artery Bypass Surgery: An Observational Study","volume":"13","author":"Wang","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Yi, J., Liang, H., Song, R., Xia, H., and Huang, Y. (2018). Maintaining Intraoperative Normothermia Reduces Blood Loss in Patients Undergoing Major Operations: A Pilot Randomized Controlled Clinical Trial. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0582-9"},{"key":"ref_24","first-page":"44","article-title":"Perioperative Glycemic Control in Patients Undergoing Cardiac Surgery","volume":"22","author":"Bednarski","year":"2025","journal-title":"Kardiochir. Torakochir. Pol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/182618680600200108","article-title":"Intensive Hyperglycemia Control Reduces Postoperative Infections after Open Heart Surgery","volume":"2","author":"Capuano","year":"2006","journal-title":"Heart Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1177\/1457496917731190","article-title":"Hyperglycemic Episodes Are Associated with Postoperative Infections After Cardiac Surgery","volume":"107","author":"Khan","year":"2018","journal-title":"Scand. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Yao, F., Yang, F., Chen, X., Liu, L., and He, Z. (2025). Glycemic Variability and Postoperative Mortality Following Cardiac Surgery: Evidence from a Real-World ICU Cohort. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-05259-6"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1213\/ANE.0000000000007803","article-title":"Patient Blood Management in Cardiac Surgery: Opportunities in Cardiac Surgery-2024 Sazama Award Lecture, Society for the Advancement of Blood Management","volume":"142","author":"Bracey","year":"2026","journal-title":"Anesth. Analg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1053\/j.jvca.2022.01.013","article-title":"Critical Preoperative Hemoglobin Value to Predict Anemia-Related Complications After Cardiac Surgery","volume":"36","author":"Kattou","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Rancati, V., Scala, E., Ltaief, Z., Gunga, M.Z., Kirsch, M., Rosner, L., and Marcucci, C. (2021). Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112454"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.bja.2021.12.019","article-title":"Increased Adherence to Perioperative Safety Guidelines Associated with Improved Patient Safety Outcomes: A Stepped-Wedge, Cluster-Randomised Multicentre Trial","volume":"128","author":"Emond","year":"2022","journal-title":"Br. J. Anaesth."},{"key":"ref_32","first-page":"e70923","article-title":"The Role of WHO Surgical Checklists in Reducing Postoperative Adverse Outcomes: A Systematic Review","volume":"16","author":"Qaiser","year":"2024","journal-title":"Cureus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1056\/NEJMsa0810119","article-title":"A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population","volume":"360","author":"Haynes","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1161\/CIR.0b013e3182a38efa","article-title":"Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork: A Scientific Statement from the American Heart Association","volume":"128","author":"Wahr","year":"2013","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"755","DOI":"10.23736\/S0021-9509.17.09866-4","article-title":"Analysis of \u201cNever Events\u201d Following Adult Cardiac Surgical Procedures in the United States","volume":"58","author":"Robich","year":"2017","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_36","first-page":"332","article-title":"Adherence to The Surgical Safety Checklist and Patient Adverse Event: A Scoping Review","volume":"10","author":"Baskoro","year":"2025","journal-title":"J. Keperawatan Suaka Insan JKSI"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"447","DOI":"10.4103\/jehp.jehp_1493_24","article-title":"Knowledge of Perioperative Care Guidelines in Cardiac Surgery and the Barriers to Their Adherence among Cardiac Nurses in a Middle Eastern Country","volume":"14","author":"Balachandran","year":"2025","journal-title":"J. Educ. Health Promot."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1051\/ject\/2025022","article-title":"Leveraging the perfusionist-surgeon dyad to improve the culture of safety","volume":"57","author":"Shann","year":"2025","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13037-024-00389-w","article-title":"The Anatomy of Safe Surgical Teams: An Interview-Based Qualitative Study among Members of Surgical Teams at Tertiary Referral Hospitals in Norway","volume":"18","author":"Vikan","year":"2024","journal-title":"Patient Saf. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e22536","DOI":"10.2196\/22536","article-title":"Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study","volume":"10","author":"Likosky","year":"2021","journal-title":"JMIR Res. Protoc."},{"key":"ref_41","first-page":"31","article-title":"Burnout and Patient Safety in Operating Room Nurses During the COVID-19 Pandemic: A Cross-Sectional Study","volume":"38","author":"Ferraiuolo","year":"2025","journal-title":"J. Perioper. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"zraf120","DOI":"10.1093\/bjsopen\/zraf120","article-title":"Timing of Antibacterial Prophylaxis and Surgical Site Infection Rates in Clean Orthopaedic and Cardiac Surgery","volume":"9","author":"Morris","year":"2025","journal-title":"BJS Open"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e01360-18","DOI":"10.1128\/AAC.01360-18","article-title":"Antimicrobial Prophylaxis for Patients Undergoing Cardiac Surgery: Intraoperative Cefazolin Concentrations and Sternal Wound Infections","volume":"62","author":"Zelenitsky","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1056\/NEJMoa0810988","article-title":"Chlorhexidine-Alcohol Versus Povidone-Iodine for Surgical-Site Antisepsis","volume":"362","author":"Darouiche","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1007\/s00134-024-07693-0","article-title":"Chlorhexidine-Alcohol Compared with Povidone-Iodine-Alcohol Skin Antisepsis Protocols in Major Cardiac Surgery: A Randomized Clinical Trial","volume":"50","author":"Boisson","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1001\/jama.2024.8531","article-title":"Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis","volume":"332","author":"Widmer","year":"2024","journal-title":"JAMA"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"7353","DOI":"10.1097\/JS9.0000000000002024","article-title":"Evaluation of the Efficacy of Chlorhexidine-Alcohol vs. Aqueous\/Alcoholic Iodine Solutions for the Prevention of Surgical Site Infections: A Systematic Review and Meta-Analysis","volume":"110","author":"Yang","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_49","first-page":"CD004122","article-title":"Preoperative Hair Removal to Reduce Surgical Site Infection","volume":"8","author":"Tanner","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"103926","DOI":"10.1016\/j.iccn.2024.103926","article-title":"A Quality Improvement Program to Reduce Surgical Site Infections after Cardiac Surgery: A 10-Year Cohort Study","volume":"87","author":"Conoscenti","year":"2025","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"265","DOI":"10.5492\/wjccm.v4.i4.265","article-title":"Deep Sternal Wound Infection after Cardiac Surgery: Evidences and Controversies","volume":"4","author":"Cotogni","year":"2015","journal-title":"World J. Crit. Care Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s13019-023-02228-y","article-title":"Review on Risk Factors, Classification, and Treatment of Sternal Wound Infection","volume":"18","author":"Song","year":"2023","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"19960","DOI":"10.1038\/s41598-025-02533-7","article-title":"A Prospective Randomized Study That Compares Three Different Dressings for the Prevention of Surgical Site Infections Following Major Heart Surgery","volume":"15","author":"Cuerpo","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jtcvs.2006.03.027","article-title":"An Evidence-Based Review of the Practice of Cardiopulmonary Bypass in Adults: A Focus on Neurologic Injury, Glycemic Control, Hemodilution, and the Inflammatory Response","volume":"132","author":"Shann","year":"2006","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1213\/ANE.0000000000002613","article-title":"The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass","volume":"126","author":"Baker","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"V\u00eertosu, D.-M., Dragomir, A., Cri\u0219an, S., Luca, S., P\u0103tru, O., B\u0103ghin\u0103, R.-M., Laz\u0103r, M.-A., Cozlac, A.-R., Iurciuc, S., and Luca, C.-T. (2026). Reduced Left Ventricular Ejection Fraction as a Marker of Vulnerability to Healthcare-Associated Infections in Coronary Care Unit Patients: A Single-Centre Cohort Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15051789"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"87","DOI":"10.31083\/j.rcm2403087","article-title":"Planned Reoperation after Cardiac Surgery in the Cardiac Intensive Care Unit","volume":"24","author":"Wang","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1055\/s-0041-1728761","article-title":"Neurological Complications of Cardiac Procedures","volume":"41","author":"Hrdlicka","year":"2021","journal-title":"Semin. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13019-024-03219-3","article-title":"Impact of Behavior Change Theory-Based Nursing Interventions on Cardiac Function Recovery and Quality of Life Among Cardiac Surgery Patients with Cardiopulmonary Bypass","volume":"20","author":"Zhao","year":"2025","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Cri\u0219an, S., B\u0103ghin\u0103, R.-M., Luca, S., P\u0103tru, O., Laz\u0103r, M.-A., V\u0103c\u0103rescu, C., Rus, M., Cozma, D., Gai\u021b\u0103, D., and Luca, C.-T. (2024). From ECG to Imaging: Challenges in the Diagnosis of Adult Congenital Heart Diseases. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164865"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2334","DOI":"10.1097\/JS9.0000000000000490","article-title":"A Comparison of the National Surgical Quality Improvement Program and the Society of Thoracic Surgery Cardiac Surgery Preoperative Risk Models: A Cohort Study","volume":"109","author":"Dyas","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Iacobescu, R.-A., Lunguleac, T., Antoniu, S., Burduloi, V.M., Bulimar, V., and Tinica, G. (2026). Risk Stratification for Postoperative Mortality in Cardiac Surgery: \u201cQuo Vadis\u201d?. Medicina, 62.","DOI":"10.3390\/medicina62030606"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1469\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:53:08Z","timestamp":1785315188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":62,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081469"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081469","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}