Original articleEpidemiology of Deep Sternal Wound Infection in Cardiac Surgery
Section snippets
Methods
From January 1998 to December 2005, 6,326 consecutive patients who underwent cardiac surgery at the authors' institution, were retrospectively analyzed. A total of 528 patients (ventricular-assist device implantation or heart transplantation, n = 221; thoracotomy approach for descending thoracic aortic surgery, n = 307) were excluded. The remaining 5,798 patients formed the study population.
The protocol was approved by the local institutional review board and is compliant with the Health
Results
A total of 5,798 patients with a mean age of 64 ± 14 years were included in this study. Sixty-two percent (n = 3,612) of patients were men. Patient demographics and distribution of risk factors are shown in Table 1. Surgical procedures included isolated CABG surgery (47%, n = 2,749), single- or multiple-valve surgery (22%, n = 1,280), combined valve/CABG procedures (16%, n = 934), and surgery involving the ascending aorta or the aortic arch (15%, n = 835). The median-predicted mortality by
Discussion
The reported incidence of DSWI has ranged from 0.5% to 6.8%.1, 7, 8 This variation may be explained by differences in study design (case control v retrospective observational studies), patient profile, type of surgical procedures performed, and definitions of DSWI. DSWI has been defined as bone-related infections with the need for surgical intervention,9, 10 but a number of studies also included superficial wound infections, consequently reporting a higher incidence of this complication.8, 11
Summary
Deep sternal infection has an incidence of 1.8% in the authors' practice. Improvements in surgical management using a staged approach with vacuum dressings have contributed to improved outcome, but mediastinitis still has a significant negative impact on long-term outcome. The most important patient-related independent risk factors for DSWI include obesity, diabetes, and aortic calcification. The main procedure-related independent risk factors identified were procedural complexity, CPB time,
References (27)
- et al.
Risk factors for mediastinitis after cardiac surgery
Ann Thorac Surg
(2004) - et al.
A decade of change–risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: A report from the STS National Database Committee and the Duke Clinical Research InstituteSociety of Thoracic Surgeons
Ann Thorac Surg
(2002) - et al.
A survey of 77 major infectious complications of median sternotomy: A review of 7,949 consecutive operative procedures
Ann Thorac Surg
(1985) - et al.
Major sternal wound infection after open-heart surgery: A multivariate analysis of risk factors in 2,579 consecutive operative procedures
Ann Thorac Surg
(1987) - et al.
Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center
Semin Thorac Cardiovasc Surg
(2004) - et al.
Mediastinitis after cardiovascular operations: A case-control study of risk factors
Ann Thorac Surg
(1998) - et al.
Mediastinitis after more than 10,000 cardiac surgical procedures
Ann Thorac Surg
(2006) - et al.
Major bleeding complicating deep sternal infection after cardiac surgery
J Thorac Cardiovasc Surg
(2003) - et al.
Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
Ann Thorac Surg
(1999) - et al.
Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting
J Thorac Cardiovasc Surg
(2003)
Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting
Ann Thorac Surg
Staged initial percutaneous coronary intervention followed by valve surgery (“hybrid approach”) for patients with complex coronary and valve disease
J Am Coll Cardiol
Vacuum-assisted closure as a treatment modality for infections after cardiac surgery
J Thorac Cardiovasc Surg
Cited by (162)
Temporal Cluster Analysis of Deep Sternal Wound Infection in a Regional Quality Collaborative
2023, Journal of Surgical ResearchAssociation between sternal wound complications and 10-year mortality following coronary artery bypass grafting
2023, Journal of Thoracic and Cardiovascular SurgeryFactors associated with deep sternal wound infection after open-heart surgery in a Danish registry
2023, American Heart Journal Plus: Cardiology Research and PracticeDeep Sternal Wound Infection and Mortality in Cardiac Surgery: A Meta-analysis
2023, Annals of Thoracic Surgery