Deep Sternal Wound Infection After Cardiac Surgery

Abstract

Background: Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. Methods: We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular surgery cases, 17,441 thoracic aortic surgery cases, 4,726 valvular surgery plus CABG cases, and 1,800 thoracic aortic surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as inhospital or 30-day mortality. Risk factors for DSWI were also examined. Results: The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve surgery, 2.8% after valve surgery plus CABG, 1.9% after thoracic aortic surgery, and 3.4% after thoracic aortic surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups.

Local prolonged release of antibiotic for prevention of sternal wound infections postcardiac surgery—A novel technology

“…No patient in the D‐PLEX group experienced an SWI (0/60) while one patient (1/21) 4.8% in the control group had an SWI. Although the overall sample size is small, the incidence of SWI in the control arm was in line with recently published infection rate data in similar patient populations 1‐12 . In our study, three different surgeons performed the surgery and therefore their techniques may vary.…”

“…Despite the measures taken for infection prevention in cardiac surgery, 7,14,27,42 DSWIs have not been eradicated in present surgical practices. Indeed, DSWI rates are particularly higher in high‐risk patients undergoing cardiac surgery 5‐12 . Since DSWI is associated with a substantial economic burden, long hospitalizations, and high morbidity and mortality rates, 17‐19 there is a real need to address this devastating complication of cardiac surgery.…”

“…The incidence of sternal wound infection (SWI) after cardiac operations involving sternotomy ranges from 1% to 3% and up to 8% in high-risk patients, [1][2][3][4][5][6][7][8][9][10][11][12] although surgical techniques and antibiotic prophylaxis have been optimized in the last few decades. Postoperative SWI can be classified either as superficial sternal wound infection (SSWI) or a deep sternal wound infection (DSWI).…”

Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery?

“…No other study has reported similar findings. Risk factors for chest infection are associated with the patients’ 2,3,61,62 preoperative, intraoperative 3 and postoperative processes. As there was no statistically significant difference in preoperative and intraoperative data between the groups and both groups received appropriate preoperative preparation, this finding may indicate that preoperative education played a role in preventing sternal infection.…”

Standardized Musculocutaneous Flap for the Coverage of Deep Sternal Wounds After Cardiac Surgery

“…In a large population-based study Sears and colleagues [21] found the 1-year mortality to be 10.7% in patients with DSWI. In another large population-based study Kubota and coworkers [22] found a higher incidence of DSWI with more complex heart interventions and the 30-day mortality to be significantly higher with reexploration for bleeding (23.0% vs 8.1%). The 14.75% mortality in our study reflects the difficulty and complexity of the treated cases.…”