Incidence of deep and superficial sternal infection after open heart surgeryA ten years retrospective study from 1981 to 1991

Abstract

Between January 1981 and December 1991, 4137 adult patients underwent various cardiac procedures via a median sternotomy under cardiopulmonary bypass. The overall infection rate was 1.33%, including superficial wound infections (SWI) (1.18%) and deep sternal infection (DSI) (0.145%). Pericardial and retrosternal suction drains with a vent allowed a better drainage of blood and serosities and probably contributed to our low DSI rate. Eleven factors predisposing to infection were evaluated by Fisher's exact test. Only the operative urgency (P = 0.006), reexploration for bleeding (P = 0.00001) and preoperative renal failure (P = 0.0005) were statistically significant. Twenty of our infected patients had no risk factors for infection. When the risk factors described in the literature were applied to our infected patients, only one had no risk factor.

Microbial Surgical Site Infections in Association with Post Cardiac Surgery

“…The rate of mortality in association with nosocomial SSIs is estimated about 77% which 93% of the deaths were belonging to patients with organ SSIs. In accordance with different recorded reports relating to previous studies, the incidence of cardiac SSIs ranges from 0.25%-4% with the mortality rate of 10%-30% [2,3,6,10,17,18].…”

Sternal Wound Complications Following Cardiac Surgery

“…In general, reported rates of DSWI are relatively low, ranging from 0.25% to 3.6 % [2-9, 38, 39, 41, 42]. However, the incidence of superficial sternal infection excedes that of deep sternal infection by as many as three times [10,41,43], and Francel has stated that as many as 70% of patients with poststernotomy infection will have superficial tissue involvement [44].…”

An approach to improve early detection of sternal wound infection

“…Approximately 1% of patients who have median sternotomy develop a superficial wound infection, usually 7-9 days after operation 1 . Deep sternal wound infection is a potentially life-threatening complication occurring in 0.4-5 percent of all open heart operations [1][2][3] .…”

“…Deep sternal wound infection is a potentially life-threatening complication occurring in 0.4-5 percent of all open heart operations [1][2][3] . It usually presents 2-4 weeks after operation, but can present months or years later 1 , and it carries a mortality of ~25% 4 . Surgical site infections include superficial incisional infections, infections of the deep incision space and organ space infections 5 .…”

“…The wound may exhibit erythema and a small amount of drainage that contains bacteria. Presenting symptoms and findings include wound drainage, fever, sternal instability, excessive wound pain, leukocytosis, and dehiscence 1,6 . Earlier recognition of sternal wound complications and aggressive treatment has probably contributed to the relatively low mortality rate seen in some studies 7 .…”