Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?

Abstract

OBJECTIVES:We studied the influence of the number of sternotomy mechanical fixation points on deep sternal wound infection (DSWI). METHODS:Between September 2007 and February 2011, 2672 patients underwent a standard peri-sternal wire closure following a median sternotomy for a first-time cardiac surgery. Data were collected during the study period. RESULTS:The mean age of the patients was 66 ± 11 and 1978 (74.0%) were male. The mean body mass index (BMI) was 28.9 ± 9.3 and the median of the logistic EuroSCORE was 3.14, with a range of 0.88-54.1. Postoperatively, 40 (1.5%) patients developed DSWI after 14 ± 6 days, of whom 39 (92.5%) had positive deep sternal wound specimen cultures, predominantly Staphylococci (62.5%). The risk of DSWI was significantly increased in patients in whom eight or fewer paired points of sternal wire fixation were used when compared with patients in whom nine or more paired points of fixation were used (P = 0.002). Preoperative myocardial infarction (P = 0.001), elevated BMI (P = 0.046), bilateral internal mammary artery harvest (P < 0.0001), postoperative hypoxia (P < 0.0001), sepsis (P = 0.019) and postoperative inotrope use (P = 0.007) significantly increased the risk of DSWI.CONCLUSIONS: DSWI is associated with hypoxia, ischaemia, sepsis and mechanical sternal instability. DSWI may be prevented by using nine or more paired fixation points when closing with standard peri-sternal wires.

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

“…Intraoperative risk factors include use of BIMA grafts [1,11,64,72,81,86,91,92], prolonged duration of surgery, perfusion time and aortic cross clamp time [11, 13, 72, 77, 79-81, 86, 95-97], redo cardiac surgery and reoperation [12,58,59,64,87,90,[101][102][103][104][105].…”

“…Postoperative risk factors include postoperative respiratory failure [1,12,59,71,85,90,92,97] and prolonged intensive care stay [64,73,80,85,106].…”

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

“…We performed a single center, retrospective review and had limited data on specifics about administration of systemic perioperative antibiotics. The frequency of DSWI declined over the study period with a notable decrease in the incidence between 2009 and 2010 (1.5% to 0.7%), probably due to implementation of updated STS antibiotic prophylaxis guidelines for cardiac surgery (5) and quality improvement campaigns for appropriate and timely administration of perioperative antibiotics, adoption of perioperative glucose management protocols (16), and patient-specific sternal closure techniques including double wires and sternal bands (17, 18). In addition, not all surgeons used vancomycin paste and there were changes in practice of the study period; however, we did not observe a relationship between individual surgeon and incidence of DSWI.…”

eComment. The number of sternal wires influences sternal wound outcome

“…The authors showed that the number of wires used has an association to DSWI, only in high-risk patients. Shaikhrezai [2] and colleagues reached the same conclusion, applied however, to every patient without identification of high-risk groups. In our practice, from February 2000 to October 2007, 120 out of 3896 cardiac surgical patients (3.02%; prospective data collection, sternal closure with 6 simple wires) developed sternal wound infections.…”