Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections?

Ngaage, Dumbor L.; Cale, Alex; Griffin, Steven; Guvendik, Levent; Cowen, Michael E.

doi:10.1016/j.ejcts.2008.01.051

Cited by 27 publications

(15 citation statements)

References 13 publications

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“…Staphylococcus aureus was the prevalent microorganism, this result was corroborated by other studies (8,25) . Regarding the mortality rate among patients with SSI, this research was 38.9%, diverging from other studies in which the frequency ranged between 2.6% and 32.1% (14,17,(22)(23)(24) . Therefore, this result indicated that the diagnosis of SSI was constituted in an aggravation of the clinical condition of the patient, which may have favored the occurrence of complications with death.…”

Section: Discussioncontrasting

confidence: 51%

“…In this study, the incidence of SSI was higher than that identified in the literature, ranging between 0.2% and 5.6% (8,10,16,(22)(23)(24)(25) . It is important to measure the rates of SSI, because they provide data that can lead to improvement of conditions observed and prevent this serious complication in patients undergoing cardiac surgery (5) .…”

Section: Discussioncontrasting

confidence: 45%

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Risk factors for surgical site infection in cardiac surgery

Silva¹,

Barbosa

2012

Acta paul. enferm.

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Objective: To analyze the occurrence of surgical site infection (SSI) in patients undergoing cardiac surgery in the period between July 2005, and July 2010. Methods: A quantitative, historical cohort study that evaluated 384 patients in a public teaching hospital. The Statistical Package for the Social Sciences software was used for data analysis and for descriptive analysis, measures of association in contigency tables and logistic regression were used. Results: It was found that 36 (9.4%) patients developed a SSI and that mortality occurred in 14 (38.9%). Staphylococcus aureus was the prevalent microorganism (12, 27.3%) In the multivariate analysis, the risk factors identified as predictors of SSI were male gender, intubation for more than 24 hours, and reintubation. Conclusion: The risk factors predictive of the occurence of SSI (p<0.05) were: male gender, reintubation, and intubation for more than 24 hours. Keywords: Surgical wound infection; Cardiac surgical procedures/adverse effects; Risk factors ResumoObjetivo: Analisar a ocorrência de infecção de sítio cirúrgico (ISC) nos pacientes submetidos à cirurgia cardíaca no período ente julho de 2005 e julho de 2010. Métodos: Estudo de abordagem quantitativa, coorte histórica que avaliou 384 pacientes de um hospital público de ensino. Foi utilizado o software Statistical Package for the Social Sciences para a análise dos dados e para a análise descritiva, foram usadas medidas de associação em tabelas de contingência e regressão logística. Resultados: Verificou-se que 36 (9,4%) pacientes evoluíram com ISC e que a mortalidade foi de 14 (38,9%). O Staphylococcus aureus foi o micro-organismo prevalente 12 (27,3%). Na análise multivariada, os fatores de risco identificados como preditores da ISC foram gênero masculino, tempo de intubação maior que 24 horas e reintubação. Conclusão: Os fatores de risco preditores para ocorrência de ISC (p<0,05) foram: gênero masculino, reintubação e tempo de intubação maior que 24 horas. Descritores: Infecção de ferida operatória; Procedimentos cirúrgicos cardíacos/efeitos adversos; Fatores de risco ResumenObjetivo: Analizar la ocurrencia de infección de sitio quirúrgico (ISC) en pacientes sometidos a cirugía cardiaca en el período entre julio del 2005 y julio del 2010. Métodos: Estudio de abordaje cuantitativo, cohorte histórica en el que se evaluó a 384 pacientes de un hospital público de enseñanza. Fue utilizado el software Statistical Package for the Social Sciences para el análisis de los datos y para el análisis descriptivo, fueron usadas medidas de asociación en tablas de contingencia y regresión logística. Resultados: Se verificó que 36 (9,4%) pacientes evolucionaron con ISC y que la mortalidad fue de 14 (38,9%). El Staphylococcus aureus fue el microorganismo prevalente 12 (27,3%). En el análisis multivariado, los factores de riesgo identificados como predictores de la ISC fueron género masculino, tiempo de intubación mayor de 24 horas y reintubación. Conclusión: Los factores de riesgo predictores para la ocurrencia de...

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Section: Discussioncontrasting

confidence: 51%

Section: Discussioncontrasting

confidence: 45%

Risk factors for surgical site infection in cardiac surgery

Silva¹,

Barbosa

2012

Acta paul. enferm.

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“…Previous studies investigating the association between early tracheostomy and deep sternal wound infection after median sternototomy showed divergent results: Whereas Ngaage et al 17 reported post-sternotomy PDT to be associated with an approximately 3-fold risk for deep sternal wound infections, others could not demonstrate any relationship between tracheostomy and mediastinitis. 18 In our cohort, none of the 14 subjects undergoing thoracic transplant with median sternotomy developed mediastinitis.…”

Section: Discussionmentioning

confidence: 77%

Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

et al. 2016

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BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, the literature lacks reports about the effectiveness and safety of this procedure in thoracic organ transplant recipients, who have increased risks of bleeding and infection. METHODS: We retrospectively reviewed the records of subjects who underwent thoracic organ transplantation at our institution between January 2004 and March 2011 followed by PDT (using the Ciaglia Blue Rhino technique with direct bronchoscopic guidance). RESULTS: From a total of 312 thoracic transplant recipients, we identified 93 (29.8%) subjects with PDT. Of these, 79 had undergone double lung transplant, 11 had undergone heart transplant, 2 had undergone combined heart-lung transplant, and 1 had undergone combined heart-kidney transplant. Mean age was 49.5 ؎ 11.2 y, and 58% of subjects were female. The mean time from intubation to PDT was 3.7 ؎ 3.4 d, and mean time from transplant to PDT was 12.6 ؎ 28.3 d. Thirty-two subjects (34.4%) underwent PDT after re-intubation. Thirtynine subjects were receiving renal replacement therapy (41.9%), and 28 had a coagulopathy (30.1%). Moderate but not significant bleeding was observed in 3 subjects. There were no major complications during PDT procedures. Forty-five subjects (48.4%) could be weaned successfully from the ventilator and the tracheostoma could be removed. Forty-eight subjects (51.6%) died due to sepsis, multi-organ failure, or transplant failure. No procedure-related deaths were noted. There were no significant late complications. Among the 45 who survived their stay in the ICU, the functional and cosmetic outcomes of PDT were excellent. CONCLUSIONS: PDT can be safely performed on patients with acute respiratory failure after thoracic organ transplantation. Therefore, we recommend the use of this technique for prolonged airway management in these patients.

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“…Tracheostomy prior to any identified SWI occurred in 411 patients (2.2%), and the median [IQR] time from post-surgical ICU admission to tracheostomy was 14 [10][11][12][13][14][15][16][17][18][19] Table 2. Tracheostomy was an independent predictor of SWI (adjusted OR 2.8; 95% CI 1.9 to 4.2).…”

Section: Resultsmentioning

confidence: 99%

“…There continues to be uncertainty as to the true nature of the relationship between tracheostomy and SWI, with recent publications both supporting and refuting tracheostomy as a cause of SWI post cardiac surgery. [5][6][7][8][9][10][11] Three large observational studies support tracheostomy as a risk factor for SWI. In a study of 6,057 patients undergoing isolated coronary artery bypass, Curtis et al 5 Two previous studies that failed to detect an association between tracheostomy and SWI were limited by small numbers of events, which precluded robust risk adjustment.…”

Section: Résumémentioning

confidence: 99%

The association between tracheostomy and sternal wound infection in postoperative cardiac surgery patients

Sun

Boodhwani

Baer

et al. 2013

Can J Anesth/J Can Anesth

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Purpose To investigate whether tracheostomy increases the risk of sternal wound infection (SWI) post cardiac surgery. Methods All patients undergoing cardiac surgery via median sternotomy from September 1997 to October 2010 were included in this retrospective observational study. Primary exposure was tracheostomy performed during admission to the cardiac surgical intensive care unit. The primary outcome was SWI during hospital admission. Multivariable logistic regression was used to determine if tracheostomy was an independent predictor of SWI. Restriction and propensity score analyses were then used to assess if tracheostomy is a causal risk factor for SWI. Results Four hundred and eleven of 18,845 patients (2.2%) were treated with tracheostomy. Incidences of SWI in tracheostomy and non-tracheostomy groups were 19.5% (80/411) and 0.8% (154/18,434), respectively. Using multivariable logistic regression analysis, tracheostomy was found to be an independent predictor of SWI (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.9 to 4.2). In an analysis restricted to respiratory failure patients, tracheostomy was associated with sternal wound infection (OR 3.4; 95% CI 2.4 to 4.9). When the analysis was stratified by the risk of receiving tracheostomy as represented by propensity score (PS), 46 patients (12%) in the intermediate risk category (PS 0.2-0.4) had SWIs (adjusted OR 2.97; 95% CI 1.6 to 5.6), and 52 patients (14%) in the highest risk category (PS [ 0.4) had SWIs (OR 1.52; 95% CI 0.85 to 2.87). Discussion Our single-centre observational study of cardiac surgery patients found tracheostomy to be an independent risk factor for SWI. Our analysis showed a robust association when restricted to patients with respiratory failure and after the population was stratified by the propensity to have a tracheostomy. Résumé

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Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections?

Abstract: Tracheostomy, often performed in high-risk patients, may further complicate recovery with sternal wound infections, including mediastinitis, therefore, patients and timing should be carefully selected for post-sternotomy tracheostomy.

Cited by 27 publications

References 13 publications

Risk factors for surgical site infection in cardiac surgery

Risk factors for surgical site infection in cardiac surgery

Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

The association between tracheostomy and sternal wound infection in postoperative cardiac surgery patients

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