Deep Sternal Wound Infections After Cardiac Surgery: A New Australian Tertiary Centre Experience

Ali, Umar; Bibo, Liam; Pierre, M.; Bayfield, Nicholas; Raichel, Lior; Merry, Christopher; Larbalestier, Robert

doi:10.1016/j.hlc.2020.02.003

Cited by 13 publications

(20 citation statements)

References 27 publications

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“…Another study showed that male gender, increased BMI, presence of left main coronary artery disease, and increased LOS were signi cantly associated with the risk of deep sternal wound infections, while the presence of hypercholesterolemia was a protective factor hypothesized to be due to long-term statin use [30]. Although studies have demonstrated statin therapy was associated with a reduced risk of postoperative infection [9,30,31], other studies including the present one did not support this nding [32,33].…”

Section: Discussioncontrasting

confidence: 60%

“…A meta-analysis including 10 cohort studies with a total of 147,263 participants showed that statin use was associated with a lower incidence of postoperative infectious complications in both cardiac and non-cardiac surgery possibly due to anti-in ammatory or immunomodulatory properties [9]. Another study showed that male gender, increased BMI, presence of left main coronary artery disease, and increased LOS were signi cantly associated with the risk of deep sternal wound infections, while the presence of hypercholesterolemia was a protective factor hypothesized to be due to long-term statin use [30]. Although studies have demonstrated statin therapy was associated with a reduced risk of postoperative infection [9,30,31], other studies including the present one did not support this nding [32,33].…”

Section: Discussionmentioning

confidence: 99%

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Effect of lipid-lowering Medications in patients with coronary artery bypass grafting surgery outcomes

Shi

Zhang

Goldhammer

et al. 2022

Preprint

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Background: Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups. Results: A total of 3,988 patients with the mean ago > 65 years old were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P<0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR)=0.856; 95% CI 0.781-0.938; P<0.001); all neurologic complications (OR=0.572; 95% CI 0.441-0.739; P<0.001) including stroke (OR=0.481; 95% CI 0.349-0.654; P<0.001); in-hospital mortality (OR=0.616; 95% CI 0.432-0.869; P=0.006; P<0.001); and overall mortality (OR=0.723; 95% CI 0.634-0.824; P<0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population. Conclusions: Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Effect of lipid-lowering Medications in patients with coronary artery bypass grafting surgery outcomes

Shi

Zhang

Goldhammer

et al. 2022

Preprint

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show abstract

“…This suggests that the percentage of patients with unbalanced diabetes mellitus or who did not stop smoking before the surgical procedure could modify the estimation of the impact of diabetes mellitus and smoking on the development of SWI across studies. Because obesity cannot be corrected quickly before elective CABG, we presume that the independent association between obesity and SWI that we and others worldwide have observed remains relevant after CABG, 30,31 but not after valve surgery. 32 In addition to SWI, preoperative anaemia has also previously been associated with death, stroke, atrial fibrillation or ARF after heart surgery.…”

Section: Discussion/conclusionmentioning

confidence: 52%

<p>Obesity and Preoperative Anaemia as Independent Risk Factors for Sternal Wound Infection After Coronary Artery Bypass Graft Surgery with Pedicled (Non-Skeletonized) Internal Mammary Arteries: The Role of Thoracic Wall Ischemia?</p>

Brunet¹,

N’Guyen²,

Lefebvre³

et al. 2020

VHRM

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Purpose Obesity remains statistically associated with coronary artery disease, for which coronary artery bypass graft surgery (CABG) remains the standard of care. However, obesity is also associated with sternal wound infection (SWI) which is a severe complication of CABG despite advances in surgery and in infection prevention and control. Strategies to reduce the incidence of SWI are still being investigated, and we therefore conducted a retrospective study to revisit factors other than obesity associated with SWI after CABG. Patients and Methods Data were extracted from the medical records of 182 patients who underwent elective on-pump CABG using one or both pedicled internal mammary artery grafts in Reims University Hospital between May 2015 and May 2016. All preoperative or perioperative variables with a p value<0.10 in univariate analysis were entered into a stepwise logistic regression model. Results Among the 182 patients (145 male (79.6%), median age 68.0 [45.0–87.0] years), 138 (75.8%) underwent CABG using bilateral internal mammary artery grafts. Median BMI was 27.7 [18.7–50.5] kg/m 2 , and there were 51 (28.0%) and 79 (43.4%) patients with obesity and overweight, respectively. Twenty-three out of the 182 patients (12.6%) developed SWI. In-hospital mortality was not statistically different between patients with and without SWI but the median length of stay was (6.0 [2.0–38.0] versus 5.0[3.0–21.0] days in the intensive care unit, p=0.03, and 26.0 [9.0–134.0] versus 9.0 [7.0–51.0] days in hospital, p<0.0001). Obesity and preoperative anaemia were independently associated with SWI, as was the number of red blood cell (RBC) units transfused (OR 14.61 [2.64–80.75], OR 4.64 [1.61–13.34] and OR 1.27 [1.02–1.58], respectively). Conclusion The independent association of SWI with the number of RBC units transfused and the existence of preoperative anaemia and obesity suggests a mechanism of thoracic wall ischemia in SWI after CABG, thus leaving insufficient perfusion of the thoracic wall in patients with obesity. Medical strategies are warranted to try to prevent this costly complication.

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“…Balachandran, Ali, and Colombier and colleagues also demonstrated that male sex, active smoking, and diabetes mellitus were independent risk factors for sternal infection. 4,20,21 After developing propensity scores from a multivariable logistic model to predict differences in baseline characteristics between the Early onset infection was more common in male patients, smokers, and those with a positive wound culture while female sex and the requirement of an urgent operation was more common in lateonset infection. After adjusting for differences between both groups, those with early onset DSWI had higher mortality, likely reflecting a greater degree of aggressiveness of these infections.…”

Section: Discussionmentioning

confidence: 99%

Early onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis

Elsayed

Carey

Cohen

et al. 2021

Journal of Cardiac Surgery

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Deep Sternal Wound Infections After Cardiac Surgery: A New Australian Tertiary Centre Experience

Cited by 13 publications

References 27 publications

Effect of lipid-lowering Medications in patients with coronary artery bypass grafting surgery outcomes

Effect of lipid-lowering Medications in patients with coronary artery bypass grafting surgery outcomes

<p>Obesity and Preoperative Anaemia as Independent Risk Factors for Sternal Wound Infection After Coronary Artery Bypass Graft Surgery with Pedicled (Non-Skeletonized) Internal Mammary Arteries: The Role of Thoracic Wall Ischemia?</p>

Early onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis

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