Case-Control Study of Risk Factors for Mediastinitis After Cardiovascular Surgery

Gude, María Jesús López; Juan, R. San; Aguado, J. M.; Maroto, Luis; López‐Medrano, Francisco; Romero, José María; Rufilanchas, Juan J.

doi:10.1017/s0195941700075366

Cited by 3 publications

(7 citation statements)

References 11 publications

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“…In any case, this factor underlines the need for a careful hemostatic technique throughout the surgical procedure, especially at the end of long and complicated cases. This independent predictor of SSWI is also present in other studies 6,7,14,16‐18,22,23,25‐27 . In addition, Boeken et al showed that if the reintervention occurred before the first six postoperative hours, the risk of SSWI problems, sepsis, renal failure, or prolonged mechanical ventilation is reduced compared to when the reintervention was performed later 28 .…”

Section: Discussionmentioning

confidence: 69%

“…The fact that patients with SSWI presented a higher prevalence of diabetes mellitus is consistent with previous studies. 1 , 2 , 4 , 6 , 8 , 14 , 16 , 22 Patients with SSWI had longer CPB times, suggesting more complex and prolonged surgical processes 1 , 22 , 23 and perhaps as a consequence, a higher incidence of postoperative renal failure. Patients with SSWI also kept the temporary pacemaker leads longer suggesting that these patients suffered more heart rhythm problems in the postoperative period, which would make it necessary to keep these temporary epicardial leads longer.…”

Section: Discussionmentioning

confidence: 99%

“…This independent predictor of SSWI is also present in other studies. 6 , 7 , 14 , 16 , 17 , 18 , 22 , 23 , 25 , 26 , 27 In addition, Boeken et al showed that if the reintervention occurred before the first six postoperative hours, the risk of SSWI problems, sepsis, renal failure, or prolonged mechanical ventilation is reduced compared to when the reintervention was performed later. 28 Thus, the need to open the surgical wound again could facilitate the access of germs from the patient's skin, from the surgeons or from the operating room external environment, forms of infection of the surgical wound that could be included in the exogenous route of surgical site infection.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study

Arribas-Leal

Rivera‐Caravaca

Hernández-Torres

et al. 2022

International Wound Journal

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Sternal surgical wound infection (SSWI) in cardiac surgery is associated with increased morbidity. We investigated the incidence of SSWI, the main germs implicated and predictors of SSWI. Prospective study including patients undergoing full median sternotomy between January 2017 and December 2019. Patients were followed‐up for 3 months after hospital discharge. All sternal wound infections up to 90 days after discharge were considered SSWI. 1004 patients were included. During follow‐up, 68 (6.8%) patients presented SSWI. Patients with SSWI had a higher incidence of postoperative renal failure (29.4% vs 17.1%, P = .007), a higher incidence of early postoperative reoperation for non‐infectious causes (42.6% vs 9.1%, P < .001), longer ICU stay (3 [2–9] days vs 2 [2–4] days, P = .006), and longer hospital stay (24.5 [14.8–38.3] days vs 10 [7–18] days, P < .001). Gram‐positive germs were presented in 49% of the cultures, and gram‐negative bacteria in 35%. Early reoperation for non‐infectious causes (OR 4.90, 95% CI 1.03–23.7), and a longer ICU stay (OR 1.37 95% CI 1.10–1.72) were independent predictors of SSWI. SSWI is rare but leads to more postoperative complications. The need for early reoperation because of non‐infectious cause and a longer ICU stay were independently associated with SSWI.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study

Arribas-Leal

Rivera‐Caravaca

Hernández-Torres

et al. 2022

International Wound Journal

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“…The dichotomous variables were diabetes mellitus (DM), 1–3,8–21,23–32,34–54,56–66,68–79,103,106–109 female gender, 1–3,9–21,23,24,26–32,34,36–65,67–76,78–80,103–109 emergent/urgent procedures,…”

Section: Resultsmentioning

confidence: 99%

“…13,21,27 The continuous variables were age (year), 2,8-10,12,13,15-17,19,21,23-26,28-30,34,36-46,48,51-58,60,61,63-67, 69,74,75,79,80,103-109 BMI (kg/m 2 ), 2,9,12,13,15,17,19,21,[23][24][25][26]28,36,38,41,46,48,51,53,55,60,63,65,69,73,103,104,106,108,109 surgery time (hour), 9,12,16,17,21,23,24,44,51,[53][54][55][58][59][60][61][...…”

Section: Investigated Variablesmentioning

confidence: 99%

Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

Chen,

Zhang,

Wang

et al. 2023

International Wound Journal

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We aimed to quantitatively and systematically elucidate the rationality of the examined variables as independent risk factors for sternal wound infection. We searched databases to screen studies, ascertained the variables to be analysed, extracted the data and applied meta‐analysis to each qualified variable. Odds ratios and mean differences were considered to be the effect sizes for binary and continuous variables, respectively. A random‐effects model was used for these procedures. The source of heterogeneity was evaluated using a meta‐regression. Publication bias was tested by funnel plot and Egger's test, the significant results of which were then calculated using trim and fill analysis. We used a sensitivity analysis and bubble chart to describe their robustness. After screening all variables in the eligible literature, we excluded 55 because only one or no research found them significant after multivariate analysis, leaving 33 variables for synthesis. Two binary variables (age over 65 years, NYHA class >2) and a continuous variable (preoperative stay) were not significant after the meta‐analysis. The most robust independent risk factors in our study were diabetes mellitus, obesity, use of bilateral internal thoracic arteries, chronic obstructive pulmonary disease, prolonged surgery time, prolonged ventilation and critical preoperative state, followed by congestive heart failure, atrial fibrillation, renal insufficiency, stroke, peripheral vascular disease and use of an intra‐aortic balloon pump. Relatively low‐risk factors were emergent/urgent surgery, smoking, myocardial infarction, combined surgery and coronary artery bypass grafting. Sternal wound infection after open‐heart surgery is a multifactorial disease. The detected risk factors significantly affected the wound healing process, but some were different in strength. Anything that affects wound healing and antibacterial ability, such as lack of oxygen, local haemodynamic disorders, malnutrition condition and compromised immune system will increase the risk, and this reminds us of comprehensive treatment during the perioperative period.

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Omental Transposition Flap for Sternal Wound Reconstruction in Diabetic Patients

Stump

Bedri²,

Goldberg³

et al. 2010

Annals of Plastic Surgery

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In 2004, we published our 12-year experience with tissue transfer for deep sternal wound infection after median sternotomy, finding increased rates of reoperation for diabetic patients. Therefore, we decided to alter our treatment approach to diabetic patients to include sternal debridement followed by omental transposition. Eleven diabetic patients underwent omental transposition by our division during the study period. Hospital records were retrospectively reviewed to determine outcomes and complications. We found that diabetic patients treated after implementation of the new treatment approach were 5.4 times less likely to require reoperation for sternal wound management than were patients in the previous series, most of whom had been treated with pectoralis muscle flaps (95% confidence interval, 0.5- 50.5). By altering our treatment approach to use omental transposition as the initial surgical therapy, we were able to demonstrate a trend toward decreased need for flap revision in diabetic patients.

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Case-Control Study of Risk Factors for Mediastinitis After Cardiovascular Surgery

Cited by 3 publications

References 11 publications

Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study

Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study

Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

Omental Transposition Flap for Sternal Wound Reconstruction in Diabetic Patients

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