Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population: a basis for a new risk model?

Abstract

Deep sternal wound infection (DSWI) is a rare but serious complication following coronary artery bypass surgery. Our study investigates the risk factors and mortality associated with DSWI with other risk models for DSWI. Data was collected prospectively on 7602 patients undergoing coronary artery bypass grafting±concomitant surgery between April 1999 and September 2009 including DSWI. All 13 Society for Thoracic Surgeons (STS) risk scoring variables were assessed using logistic regression in relation to developing DSWI. The STS risk scores were evaluated using the area under the receiver operating curve. A total of 44 (0.59%) patients developed DSWI. These patients had a higher mortality (9.1%) than patients without DSWI (2.6%) (P=0.03). The mean preoperative and combined STS scores were significantly higher in the DSWI patient group compared to the non-DSWI group (9.46±4.30 and 8.76±3.86 vs. 7.07±4.25 and 6.51±4.11, P=0.0003 and P=0.0005, respectively). Logistic regression identified age [odds ratio (OR)=1.055], body mass index (OR=1.076), diabetes (OR=2.00) and chronic lung disease (OR=2.47) as the significant independent determinants of DSWI from the variables considered. Mortality rates and mean STS scores are higher in patients requiring re-opening for DSWI. Not all the STS risk factors were predictors of DSWI in our population.

Fatores de risco para infecção de ferida esternal e aplicação do escore da STS em pacientes submetidos à cirurgia de revascularização miocárdica

“…The higher rate of SWI found in the current study may be due to the post-discharge notification, which was different from what has been published in scientific journals [12,17].…”

“…Recent studies [17,28,29] have found some different risk factors for SWI, identifying age, COPD and reoperation as markers. These differences may be attributed to population differences.…”

Efficacy and Safety of Bone Wax to Reduce Sternal Bleeding Following Coronary Bypass Surgery

“…In a study performed with 7602 patients who had undergone coronary bypass surgery, deep sternal wound infection, and mortality rates were found to be 0.59%, and 9.1%, respectively. 2) In various studies, mortality rates associated with mediastinitis have ranged between 10% and 47%. 3) Advanced age, male gender, NYHA (New York Heart Association) class ≥3, left main coronary stenosis, bilateral internal mammary artery harvesting, body mass index over 30 kg/m 2 , chronic obstructive pulmonary disease, smoking, diabetes mellitus, prolonged mechanical ventilation, re-exploration due to bleeding and massive blood transfusion are found to be the independent risk factors for mediastinitis.…”

“…However, it is also pointed out that bone wax has an alleviating effect on infections and wound healing inhibitors. 2) In the present study, we aimed to investigate abovementioned effects of bone wax.…”

Sternal Wound Complications Following Cardiac Surgery

“…The Fowler model also provides for inclusion of important intraoperative details known to influence postoperative infection including the need for intra-aortic balloon counterpulsation and prolonged cardiopulmonary bypass times [13]. Although the model devised by Fowler et al was based on various cases of major infection after coronary artery surgery, including DSWI, the authors did validate the model as predictive of infection in a test population from the STS Database, and the model was also recently validated in a different cohort of patients from the UK as being predictive of DSWI [38]. The EuroSCORE system also has been shown to predict infection and associated mortality with acceptable discrimination [39].…”