Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality

Abstract

BackgroundSternal wound infection (SWI) is an uncommon but potentially life-threatening complication of cardiac surgery. Predisposing factors for SWI are multiple with varied frequencies in different studies. The purpose of this study was to assess the incidence, risk factors, and mortality of SWI after coronary artery bypass grafting (CABG) at Tehran Heart Center.MethodsThis study prospectively evaluated multiple risk factors for SWI in 9201 patients who underwent CABG at Tehran Heart Center between January 2002 and February 2006. Cases of SWI were confirmed based on the criteria of the Centers for Disease Control and Prevention. Deep SWI (bone and mediastinitis) was categorized according to the Oakley classification.ResultsIn the study period, 9201 CABGs were performed with a total SWI rate of 0.47 percent (44 cases) and deep SWI of 0.22 percent (21 cases). Perioperative (in-hospital) mortality was 9.1% for total SWI and about 14% for deep SWI versus 1.1% for non-SWI CABG patients. Female gender, preoperative hypertension, high functional class, diabetes mellitus, obesity, prolonged intubation time (more than 48 h), and re-exploration for bleeding were significant risk factors for developing SWI (p = 0.05) in univariate analysis. In multivariate analysis, hypertension (OR = 10.7), re-exploration (OR = 13.4), and female gender (OR = 2.7) were identified as significant predictors of SWI (p < 0.05 for all). The rate of SWI was relatively similar in 3 groups of prophylactic antibiotic regimen (Cefazolin, Cefazolin + Gentamycin and Cefazolin + Amikacin: 0.5%, 0.5%, and 0.34% respectively).ConclusionRarely reported previously, the two risk factors of hypertension and the female gender were significant risk factors in our study. Conversely, some other risk factors such as cigarette smoking and age mentioned as significant in other reports were not significant in our study. Further studies are needed for better documentation.

Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica

“…We did not observe, however, the association between age, obesity [7,14,20], females [28,29] and presence of hypertension [29] with the development of infection, described in other series. Longer duration of central venous catheter and cardiac catheterization during hospitalization as independent predictors of development of any infection in the postoperative period of CABG were shown only in our study, regardless of the presence of DM they retained their association with the risk of infection.…”

Incidence and Predictor of Post-Operative Wound Infection in Patients Underwent Coronary Artery Bypass Grafting

“…JY Bhatia, et al [15] demonstrated high rate of incidence rate of WI in patients underwent CABG as (18.86%). Kay AE [13] and Omran AS, et al [14] found that incidence of WI was 24.4%. This dissimilarity was due to differences in the sample size of the present study.…”

“…McConkey SJ [12], Borger MA [9] and Stahle E, et al [10] found that WI was more in male than female (84.4% vs. 15.6%). Omran AS, et al [14] established that WI is more prevalent in male patients compared to female patients (74.5% vs. 25.5%). Another study by Hoseini MJ, et al [17] found that WI was more in male than female (99.8% vs. 0.2%), due to bias in selection of female patient.…”

“…Sajja LR, et al [18] found that average age of the patient was 57.8 ± 7.43 years. Omran AS, et al [14] demonstrated that the average age of the patient was 58.5 ± 9.7 years. Ridderstolpe L, et al [5] reported that average age of the patient was 65.4 ± 10.5 years.…”

Relationship Between Elevated HbA1c and Deep Sternal Wound Infection in Patients Undergoing Cardiac Surgery

“…The incidence of deep sternal wound infections (DSWIs) is between 0.4 and 5% following cardiac surgery and is associated with signifi cant perioperative morbidity and mortality (1)(2)(3)(4) . The associated mortality is reported to be as high as 47% (5) .…”