Original article: general thoracic
Variables predicting adverse outcome in patients with deep sternal wound infection

https://doi.org/10.1016/S0003-4975(00)02137-8Get rights and content

Abstract

Background. Mortality after deep sternal wound infection (DSWI) ranges between 5% and 47%. Variables predicting hospital mortality and prolonged hospital stay are still to be assessed.

Methods. Among 13,420 patients who underwent cardiac surgery in our institution between 1979 and 1999, DSWI developed in 112 cases (0.8%). Multiple variables were recorded prospectively and analyzed retrospectively as predictors of hospital death and prolonged (>30 days) hospital stay. The analyzed variables were divided into three groups: (1) related to the patient, including demographic variables and preoperative conditions; (2) related to cardiac operation; and (3) related to infection. Predictive variables were assessed by univariate and multivariate logistic regression analysis.

Results. Hospital mortality was 16.9%. The hospital stay of the 93 discharged patients ranged between 16 and 180 days (mean 31.3 ± 15.2). Length of cardiac operation, length of stay in intensive care unit, interval between symptoms of DSWI and wound debridement were found to be the most significant predictors of bad outcome following DSWI.

Conclusions. In our study demographic variables and preoperative conditions did not affect the prognosis of DSWI. Lower mortality rate and shorter hospital stay could be achieved with earlier and aggressive treatment of DSWI.

Section snippets

Patients and methods

Between January 1979 and January 1999, 13,420 patients underwent open heart surgery through a complete median sternotomy at our institution: the perioperative protocol of infection control remained almost unchanged over the years.

Elective patients were showered and shaved the day of their operation. In all cases, since the morning of the operation, patients received intravenous cephalosporins and intramuscolar aminoglycosides, until central line and drains were removed.

The operative field was

Results

Nineteen patients (16.9%) died during their hospital stay. Causes of death included sepsis in 8 cases, respiratory failure in 4, multiorgan failure in 4, massive bleeding from the aortic cannulation site in 1 and from right ventricular tear in 1, and cardiac failure in 1.

Wound healing was observed in 93 cases. Hospital stay ranged between 16 and 180 days (mean 31.3 ± 15.2). Germs isolated from wound secretions or from mediastinal fluid are reported in Table 2.

Follow-up time ranged between 6

Comment

Mediastinal infection is a dreadful complication of open-heart surgery. Simple medical treatment is often ineffective; infection may cause septicemia or propagate to the cardiac sutures leading to massive hemorrhage 1, 2. Reoperation is mandatory; nevertheless infection may continue, leading to local and systemic complications. Treatment is distressing for both the patient and the surgeon, because the rate of failure is high and the dressing may be painful and time consuming. Hospitalization

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