Risk factors for wound infection after off-pump coronary artery bypass grafting: Should bilateral internal thoracic arteries be harvested in patients with diabetes?

Nakano, Jota; Okabayashi, Hitoshi; Hanyu, Michiya; Soga, Yoshiharu; Nomoto, Takuya; Arai, Yoshinori; Matsuo, Takaaki; Kai, Masashi; Kawatou, Masahide

doi:10.1016/j.jtcvs.2007.11.008

Cited by 68 publications

(60 citation statements)

References 35 publications

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“…This appears to be particularly important in diabetic patients suffering from coronary artery disease. However, bilateral ITA grafting increases the incidence of sternal wound infection resulting from a decrease in sternal blood flow, contributing to the widespread practice among surgeons of avoiding the routine application of bilateral ITA grafts, especially in diabetic patients, due to fear of deep sternal wound infection (DSWI), sternal dehiscence, and even mediastinitis [8,9,10,11]. Unfortunately, avoiding the routine application of bilateral ITA grafts may deny a survival benefit to diabetic patients who may stand to benefit the most from the long-term effects of bilateral ITA grafting.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Deep Sternal Wound Infection in Diabetic Patients Undergoing Off-Pump Skeletonized Internal Thoracic Artery Grafting

Ding

Ji²,

Shi³

et al. 2015

Cardiology

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Objectives: To evaluate the impact of skeletonized bilateral or single internal thoracic artery (ITA) grafting on the risk of deep sternal wound infection (DSWI) in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: A total of 803 diabetic patients undergoing OPCAB surgery from January 2010 to December 2014 were enrolled into this study and assigned to the pSITA group (patients undergoing pedicled single ITA grafting, n = 362), the sSITA group (skeletonized single ITA grafting, n = 295), or the sBITA group (skeletonized bilateral ITA grafting, n = 146). The primary end point was the diagnosis of a DSWI. Results: Eighteen patients developed postoperative DSWI, with an incidence of 2.2%. Patients in the sSITA group had a significantly lower incidence of DSWI than those in the pSITA group (1.0 vs. 3.6%, p = 0.0408). In multivariate logistic regression analysis, the risk of DSWI in the sSITA group was 0.41 times that in the pSITA group. Conclusions: sSITA grafting lowered the risk of DSWI in diabetic patients undergoing OPCAB surgery compared to pSITA grafting. Multicenter clinical trials involving larger sample sizes are needed to determine the merit of pSITA grafting in reducing the risk of DSWI following OPCAB surgery.

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Section: Introductionmentioning

confidence: 99%

Incidence of Deep Sternal Wound Infection in Diabetic Patients Undergoing Off-Pump Skeletonized Internal Thoracic Artery Grafting

Ding

Ji²,

Shi³

et al. 2015

Cardiology

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“…Sex is one such individual feature. Male sex was determined as a predictor of major infections after sur- [9] 2008 55/43 1500 Prospective Adult CABG Lopez Gude et al [26] 2006 109/54 490 Prospective Adult Combined Filsoufi et al [21] 2009 42/64 5798 Retrospective Adult CABG Ridderstolpe et al [31] 2001 213/78 3008 Retrospective Adult Combined Tiveron et al [25] 2012 26/9 2768 Prospective Adult Combined Newman et al [35] 1988 58/10 204 Retrospective Adult Combined Wouters et al [27] 1994…”

Section: Discussionmentioning

confidence: 99%

“…[6] There are many risk factors for the development of mediastinitis: diabetes mellitus, obesity, age, peripheral artery disease, smoking, previous cardiac surgery, >5-h long surgery, and length of stay in intensive care unit. [7,8] There are few clinical studies alleging that sex is a risk factor for the development of mediastinitis after cardiac surgery; [9,10] however, there is no evidence. Therefore, we aimed to analyze whether sex is a risk factor for the development of mediastinitis after cardiac surgery.…”

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confidence: 99%

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Does gender predict development of mediastinitis?

Öztürk

2017

EJMO

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T he rate of developing mediastinitis after cardiac surgery is approximately 0.8%-5.6%. [1,2] Although the rate of occurrence of mediastinitis is low, mediastinitis causes complications, such as the need for intra-aortic balloon pump or inotropic drug support, ventricular or supraventricular arrhythmias, stroke, and myocardial ischemia, leading to reduction in long-term survival. [3,4] Mediastinal infections can be caused by direct contamination, hematogenous spread, or through extension of infection from the neck, retroperitoneum, lung, pleura, or chest wall.[5] Mediastinal infections are defined as microbiological or clinical infection of presternal tissue. There are two types of mediastinal infections: superficial or deep wound infections (mediastinitis).[6] Superficial wound infections involve only the skin and subcutaneous tissue; however, mediastinitis is the wound infection that includes sternal osteomyelitis which spreads to retrosternal space. [6] There are many risk factors for the development of mediastinitis: diabetes mellitus, obesity, age, peripheral artery disease, smoking, previous cardiac surgery, >5-h long surgery, and length of stay in intensive care unit. [7,8] There are few clinical studies alleging that sex is a risk factor for the development of mediastinitis after cardiac surgery; [9,10] however, there is no evidence. Therefore, we aimed to analyze whether sex is a risk factor for the development of mediastinitis after cardiac surgery. Methods Search StrategyWe searched PubMed database for articles according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) [11] to determine whether the sex of patients could predict devel- Objectives:We aimed to analyze whether sex was a risk factor for the development of mediastinitis after cardiac surgery. Methods: Literature screening was performed using PubMed database without date limitation. Trial results were evaluated with random or fixed-effect model according to the heterogeneity. Statistical evaluation was performed. Results: In total, 4044 articles were obtained after database searching. Of all these articles, 32 articles containing 1.11.303 patients, which satisfied the inclusion criteria, were included in the meta-analysis. The rate of mediastinitis was 2.19%. The effect size was observed as heterogeneous (Q: 89.09, df(Q): 31, p:0.00, I2:65.20%). Analysis results according to the random effect model were as follows: OR (odds ratio), 1.09; 95% CI, 0.90-1.32; and p=0.34 (p>0.05). Conclusion:The results of the quantitative analysis showed that a patient's sex does not predict the development of mediastinitis after cardiac surgery for children and/or adults.

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“…95 However, the use of BITA results in greater sternal wound complications in patients with DM (especially insulin-treated). 96,97 Harvesting skeletonized ITA may reduce the risk of sternal wound complications associated with BITA by minimizing the risk of devascularization of the sternum as compared with removal with an attached muscle pedicle. 95,98 Therefore, some surgeons believe that DM is not a contraindication for skeletonized BITA.…”

Section: Graft Selection and Patency In Dm Patientsmentioning

confidence: 99%