Cor Vasa 2015, 57(2):e75-e81 | DOI: 10.1016/j.crvasa.2015.02.014

A retrospective analysis of deep sternal wound infections after longitudinal median sternotomy

David Nešpor*, Jiří Fabián, Petr Němec
Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Median sternotomy is the most commonly performed surgical procedure in the treatment of heart conditions in both adults and children. Deep sternal wound infections (DSWI) present a serious complication occurring after surgery, highly demanding both of patients and surgery departments.
The present study is a retrospective analysis of 9 110 patients who underwent a cardiac surgery at the Center of Cardiovascular Surgery and Transplantations, Brno, Czech Republic, in the years 2005-2012, and as its objective it has a definition of risk factors of DSWI after median sternotomy.
In this study, a multivariate analysis found sepsis to be the most serious risk factors, as well as harvesting of the mammary artery (to be used as a graft for revascularisation), hemodynamic instability, reintubation and male sex.

Keywords: Cardiac surgery; Risk factors; Sepsis; Sternotomy; Sternum; Wound infections

Received: February 11, 2015; Revised: February 21, 2015; Accepted: February 24, 2015; Published: April 1, 2015  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Nešpor D, Fabián J, Němec P. A retrospective analysis of deep sternal wound infections after longitudinal median sternotomy. Cor Vasa. 2015;57(2):e75-81. doi: 10.1016/j.crvasa.2015.02.014.
Download citation

References

  1. H. Milton, Mediastinal surgery, Lancet 149 (1897) 872-875. Go to original source...
  2. M.L. Dalton, S.R. Connally, W.C. Sealy, Julian's reintroduction of Milton's operation, Annals of Thoracic Surgery 53 (1992) 532-533. Go to original source... Go to PubMed...
  3. N. Durrleman, G. Massard, Sternotomy, Multimedia Manual of Cardiothoracic Surgery 2006 (January) (2006), http://dx.doi.org/10.1510/mmcts.2006.001875. Go to original source... Go to PubMed...
  4. R.M. El Oakley, J.E. Wright, Postoperative mediastinitis: classification and management, Annals of Thoracic Surgery 61 (1996) 1030-1036. Go to original source... Go to PubMed...
  5. T.C. Horan, M. Andrus, M.A. Dudeck, CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting, American Journal of Infection Control 36 (2008) 309-332. Go to original source... Go to PubMed...
  6. J. Sjögren, R. Gustafsson, J. Nilsson, et al., Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment, Annals of Thoracic Surgery 79 (2005) 2049-2055. Go to original source... Go to PubMed...
  7. J. Sjögren, A. Mokhtari, R. Gustafsson, et al., Vacuum-assisted closure therapy for deep sternal wound infections: the impact of learning curve on survival and predictors for late mortality, International Wound Journal 5 (2008) 216-223. Go to original source... Go to PubMed...
  8. V.G. Fowler, S.M. O'Brien, L.H. Muhlbaier, et al., Clinical predictors of major infections after cardiac surgery, Circulation 112 (2005) I358-I365. Go to original source... Go to PubMed...
  9. G. Prabhakar, C.K. Haan, E.D. Peterson, et al., The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons' database, Annals of Thoracic Surgery 74 (2002) 1125-1131. Go to original source... Go to PubMed...
  10. I. Risnes, M. Abdelnoor, S.M. Almdahl, J.L. Svennevig, Mediastinitis after coronary artery bypass grafting risk factors and long-term survival, Annals of Thoracic Surgery 89 (2010) 1502-1509. Go to original source... Go to PubMed...
  11. C. Cayci, M. Russo, F. Cheema, et al., Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis, Annals of Plastic Surgery 61 (2008) 294-301. Go to original source... Go to PubMed...
  12. C.A. Milano, K. Kesler, N. Archibald, et al., Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival, Circulation 92 (1995) 2245-2251. Go to original source... Go to PubMed...
  13. I.K. Toumpoulis, The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting, Chest 127 (2005) 464. Go to original source... Go to PubMed...
  14. S.A. Nashef, F. Roques, P. Michel, et al., European system for cardiac operative risk evaluation (EuroSCORE), European Journal of Cardio-Thoracic Surgery 16 (1999) 9-13. Go to original source... Go to PubMed...
  15. F. Roques, P. Michel, A.R. Goldstone, S.A.M. Nashef, The logistic EuroSCORE, European Heart Journal 24 (2003) 881-882. Go to original source... Go to PubMed...
  16. G.E. Cimochowski, M.D. Harostock, R. Brown, et al., Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics, Annals of Thoracic Surgery 71 (2001) 1572-1579. Go to original source... Go to PubMed...
  17. A. Konvalinka, L. Errett, I.W. Fong, Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery, Journal of Hospital Infection 64 (2006) 162-168. Go to original source... Go to PubMed...
  18. K.A. Eagle, R.A. Guyton, R. Davidoff, et al., ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery), Journal of the American College of Cardiology 44 (2004) 1146-1154. Go to original source... Go to PubMed...
  19. J.D. Puskas, A. Sadiq, T.A. Vassiliades, et al., Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients, Annals of Thoracic Surgery 94 (2012) 710-716. Go to original source... Go to PubMed...
  20. S. Itagaki, P. Cavallaro, D.H. Adams, J. Chikwe, Bilateral internal mammary artery grafts, mortality and morbidity: an analysis of 1 526 360 coronary bypass operations, Heart 99 (2013) 849-853. Go to original source... Go to PubMed...
  21. S.R. Hazelrigg, H.A. Wellons Jr., J.A. Schneider, P. Kolm, Wound complications after median sternotomy. Relationship to internal mammary grafting, Journal of Thoracic and Cardiovascular Surgery 98 (1989) 1096-1099. Go to original source... Go to PubMed...
  22. D.M. Cosgrove, B.W. Lytle, F.D. Loop, et al., Does bilateral internal mammary artery grafting increase surgical risk?, Journal of Thoracic and Cardiovascular Surgery 95 (1988) 850-856. Go to original source... Go to PubMed...
  23. N.T. Kouchoukos, T.H. Wareing, S.F. Murphy, et al., Risks of bilateral internal mammary artery bypass grafting, Annals of Thoracic Surgery 49 (1990) 210-219. Go to original source... Go to PubMed...
  24. S. Saso, D. James, J.A. Vecht, et al., Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection, Annals of Thoracic Surgery 89 (2010) 661-670. Go to original source... Go to PubMed...
  25. P.B. Rahmanian, D.H. Adams, J.G. Castillo, et al., Predicting hospital mortality and analysis of long-term survival after major noncardiac complications in cardiac surgery patients, Annals of Thoracic Surgery 90 (2010) 1221-1229. Go to original source... Go to PubMed...
  26. F. Filsoufi, J.G. Castillo, P.B. Rahmanian, et al., Epidemiology of deep sternal wound infection in cardiac surgery, Journal of Cardiothoracic and Vascular Anesthesia 23 (2009) 488-494. Go to original source... Go to PubMed...
  27. M. Wolff, S. Witchitz, C. Chastang, et al., Prosthetic valve endocarditis in the ICU: prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision, Chest 108 (1995) 688-694. Go to original source... Go to PubMed...
  28. M.A. Borger, V. Rao, R.D. Weisel, et al., Deep sternal wound infection: risk factors and outcomes, Annals of Thoracic Surgery 65 (1998) 1050-1056. Go to original source... Go to PubMed...
  29. C. Heilmann, R. Stahl, C. Schneider, et al., Wound complications after median sternotomy: a single-centre study, Interactive Cardiovascular and Thoracic Surgery (2013) ivs554. Go to original source...
  30. J.C. Guaragna, L.M. Facchi, C.G. Baião, et al., Predictors of mediastinitis after cardiac surgery, Revista Brasileira de Cirurgia Cardiovascular 19 (2004) 165-170. Go to original source...
  31. P.B. Rahmanian, D.H. Adams, J.G. Castillo, et al., Tracheostomy is not a risk factor for deep sternal wound infection after cardiac surgery, Annals of Thoracic Surgery 84 (2007) 1984-1991. Go to original source... Go to PubMed...
  32. T. Nagachinta, M. Stephens, B. Reitz, B.F. Polk, Risk factors for surgical-wound infection following cardiac surgery, Journal of Infectious Diseases 156 (1987) 967-973. Go to original source... Go to PubMed...




Cor et Vasa

You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.