Predisposing factors for deep sternal wound infection after cardiac surgery (original) (raw)
Related papers
Risk factors and treatment of deep sternal wound infection after cardiac operation
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2003
Although deep sternal wound infection (DSWI) after cardiac surgery is infrequent, its consequences are serious. The purposes of this study were to define the risk factors, and to establish the best surgical treatment for DSWI. Retrospective analysis for 863 patients who underwent cardiac surgery was performed. The patients were divided into the DSWI group (n=17) and the non-infection group (n=846). Preoperative, perioperative, and postoperative variables were compared between the two groups using univariate and multivariate logistic regression analysis. The modality of treatment for DSWI was also analyzed. The incidence of DSWI was 1.97%. Independent predictors for DSWI were concomitant coronary artery bypass grafting (CABG) with valve or aortic surgery [odds ratio, 4.1; 95% confidence interval, (1.1, 15.1)] and postoperative use of intraaortic balloon pumping [4.4, (1.6, 12.3)]. An independent predictor in isolated CABG patients was emergency operation [10.9, (2.7, 44.7)]. Four of ...
Heart, Lung and Circulation, 2011
Background: Deep sternal wound infection (DSWI) is a rare but severe complication following cardiac surgery. Our study investigated the risk factors and treatment options for patients who developed DSWI at our institution between May 1988 and April 2008. Method: Data was collected prospectively in a database and information on demographics reviewed retrospectively on 5649 patients who underwent cardiac surgery during this period. Results: The incidence of DSWI was 34/5649 (0.6%). These patients were older (mean age 66.1 vs. 64.5), more likely to die (in hospital mortality 11.8% vs. non DSWI group 1.8%) and had longer hospital stays (DSWI group mean stay 25 days vs. non DSWI group 9 days). Using Fisher's exact test the risk predictors for DSWI determined at our institution included diabetes managed with oral medications (p = 0.021), previous cardiac surgery (p = 0.038), BMI ≥ 30 (p = 0.041), LVEF ≤ 30 (p = 0.010), IABP usage (p = 0.028) and homologous blood usage (p < 0.001). Most commonly bilateral pectoralis major muscle flap (BPMMF) was used for treatment of DSWI (11/30, 36.7%). Conclusion: Ultimately our data was comparable to published data in the literature on known risk predictors.
Deep Sternal Wound Infection After Cardiac Surgery
Recent clinical techniques, results, and research in wounds, 2018
Background: Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. Methods: We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular surgery cases, 17,441 thoracic aortic surgery cases, 4,726 valvular surgery plus CABG cases, and 1,800 thoracic aortic surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as inhospital or 30-day mortality. Risk factors for DSWI were also examined. Results: The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve surgery, 2.8% after valve surgery plus CABG, 1.9% after thoracic aortic surgery, and 3.4% after thoracic aortic surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups. Conclusions: The incidence of DSWI after cardiac surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac surgery.
Deep Sternal Wound Infection After Cardiac Surgery: Modality of Treatment and Outcome
The Annals of Thoracic Surgery, 2005
Background: Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. Methods: We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular surgery cases, 17,441 thoracic aortic surgery cases, 4,726 valvular surgery plus CABG cases, and 1,800 thoracic aortic surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as inhospital or 30-day mortality. Risk factors for DSWI were also examined. Results: The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve surgery, 2.8% after valve surgery plus CABG, 1.9% after thoracic aortic surgery, and 3.4% after thoracic aortic surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups.
Epidemiology of Deep Sternal Wound Infection in Cardiac Surgery
Journal of Cardiothoracic and Vascular Anesthesia, 2009
The aim of this study was to investigate the incidence and predictors of deep sternal wound infection (DSWI) in a contemporary cohort of patients undergoing cardiac surgery. The early and late outcomes of patients with this complication also were analyzed. Design: A retrospective study of consecutive patients undergoing cardiac surgery using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively. Setting: A university hospital (single institution). Participants: Five thousand seven hundred ninety-eight patients who underwent cardiac surgery between January 1998 and December 2005 including isolated coronary artery bypass graft (CABG) (n ؍ 2,749, 47%), single-or multiplevalve surgery (n ؍ 1,280, 22%), combined valve and CABG procedures (n ؍ 934, 16%), and surgery involving the ascending aorta or the aortic arch (n ؍ 835, 15%). Interventions: None. Measurements and Main Results: The overall incidence of DSWI was 1.8% (n ؍ 106). The highest rate of DSWI occurred after combined valve/CABG surgery (2.4%, n ؍ 22) and aortic procedures (2.4%, n ؍ 19). Multivariate analysis revealed 11 predictors of DSWI: obesity (odds ratio [OR] ؍ 2.2), previous myocardial infarction (OR ؍ 2.1), diabetes (OR ؍ 1.7), chronic obstructive pulmonary disease (OR ؍ 2.3), preoperative length of stay >3 days (OR ؍ 1.9), aortic calcification (OR ؍ 2.7), aortic surgery (OR ؍ 2.4), combined valve/CABG procedures (OR ؍ 1.9), cardiopulmonary bypass time (OR ؍ 1.8), re-exploration for bleeding (OR ؍ 6.3), and respiratory failure (OR ؍ 3.2). The mortality rate was 14.2% (n ؍ 15) versus 3.6% (n ؍ 205) in the control group (p < 0.001). One-and 5-year survival after DSWI were significantly decreased (72.4% ؎ 4.4% and 55.8% ؎ 5.6% v 93.8% ؎ 0.3% and 82.0% ؎ 0.6%, p < 0.001). Conclusion: DSWI remains a rare but devastating complication and is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival.
Early and late sternal wound infections following open heart surgery
2013
Infections of the sternal wound are among the most serious complications after open heart surgery. These infections result in increased morbidity for patients, can sometimes be fatal, and are associated with increased costs. Deep sternal wound infections (DSWIs) are the most common and serious of these infections. Late infections, which can result in formation of sternocutaneous fistulas (SCFs), are encountered less often, although they often represent a complex surgical problem involving several hospital admissions, prolonged antibiotic treatment, and repeated wound debridements. For the last two decades, more efficient treatments have been developed for these infections, which has lowered mortality-especially after the introduction of negative-pressure wound therapy (NPWT). In NPWT, polyurethane foam is placed in a debrided wound covered with a sterile wound drape, and a tube for transmission of negative pressure to facilitate wound healing is attached, increasing the likelihood of successful closure. The aims of the work presented in this thesis, which consists of four peer reviewed papers (I-IV), were twofold. First, to analyze the incidence, risk factors, microbiology, and outcome of DSWI in Iceland, concentrating on the outcome of NPWT. Second, to study the same outcome parameters for SCF in two well-defined cohorts of patients, one in Sweden and the other in Iceland. Clinical information was gathered from hospital charts and was registered electronically. When possible risk factors for both DSWI and SCF were evaluated, multivariate analysis was used with a case-control design and survival was analyzed using either direct comparison or the Kaplan-Meier method. In Paper I, a population-based study of DSWI in Iceland is described, involving a total of 41 patients diagnosed between 1997 and 2004, or 2.5% of all patients who underwent open heart surgery during the period. The most common pathogens were Staphylococcus aureus and coagulase-negative staphylococci (CoNS) in 41% and 37% of cases, respectively. The strongest independent risk factors were: peripheral arterial disease (odds ratio (OR) = 6.4), re-operation due to bleeding (OR = 4.5), cerebrovascular accident (OR = 4.3), obesity (OR = 3.0), low left ventricular ejection fraction (OR = 2.9), and history of smoking (OR = 2.9). The in-hospital mortality during this study period was 10% among DSWI cases, as compared to 4% in controls (p = 0.17). The one-year mortality was significantly higher in DSWI cases: 17% vs. 6% (p = 0.02). Patients with DSWI stayed an average of 33 days longer in hospital for treatment.
Serious non-fatal complications of cardiac surgery include deep sternal wound infection (DSWI) and haemorrhage. Understanding the factors associated with these complications (both pre-operatively and intra-operatively) may aid in the prevention and avoidance of such complications. The aim of the current report is to identify factors associated with DSWI and haemorrhage for all patients undergoing cardiac surgical procedures in Victorian public hospitals from July 2001 to June 2005. Multiple logistic regression analysis incorporating preoperative and intraoperative variables was used to identify risk factors for DSWI and haemorrhage. There were 153 cases of DSWI (1.3%) and 413 cases of haemorrhage (3.5%) in 11,848 patients. The risk factors differ between DSWI and haemorrhage, with pre-operative factors being more commonly associated with DSWI and intra-operative factors associated with haemorrhage. Strategies directed towards minimising modifiable pre-operative risk factors (diabete...
Deep Sternal Wound Infections After Cardiac Surgery: A New Australian Tertiary Centre Experience
Heart, Lung and Circulation, 2020
Background Deep sternal wound infections (DSWI) after cardiac surgery impose a significant burden to patient outcomes and health care costs. The objective of this study is to identify risk factors, microbiological characteristics and protective factors for deep sternal wound infections following cardiac surgery in an Australian hospital. Methods We performed a retrospective study on 1,902 patients who underwent cardiac surgery at Fiona Stanley Hospital, a tertiary hospital in Western Australia from February 2015 to April 2019. Patients were grouped into having either deep sternal wound infections or no wound infections. Results Of 1,902 patients, 26 (1.4%) patients had DSWI. On multivariate analysis, male gender was associated with DSWI with an adjusted odds ratio of 7.390 (95% CI 1.189-45.918, p=0.032). Increased body mass index (BMI) had an odds ratio of 1.101 (95% 1.03-1.18, p=0.008). Increased length of stay (LOS) had an odds ratio of 1.05 (95% CI 1.02-1.08, p=0.002). Left main disease had an odds ratio of 3.076 (95% CI 1.204-7.86, p=0.019). The presence of hypercholesterolaemia had an odds ratio of 0.043 (95% CI 0.009-0.204, p,0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most common organisms found in deep sternal wound infections (23.1% and 26.9% respectively). Polymicrobial growth occurred in 19.2% of patients. One gram of topical cephazolin was applied in 315 patients. None of these patients developed a deep sternal wound infection (p=0.022). Conclusion In a large Australian tertiary centre, male gender, increased BMI, presence of left main coronary artery disease, and increased length of hospital stay are significantly associated with the risk of deep sternal wound infections. Staphylococcus aureus and Staphylococcus epidermidis are common organisms in deep sternal wound infections. Topical antibiotics such as cephazolin are useful in preventing deep sternal wound infections. The presence of hypercholesterolaemia is a protective factor and we hypothesise that this is due to long-term statin use.