Prevention of deep sternal wound infection in cardiac surgery: a literature review

Vos, Roemer J.; Putte, Bart P. van; Kloppenburg, Geoffrey T.L.

doi:10.1016/j.jhin.2018.05.026

Cited by 58 publications

(45 citation statements)

References 70 publications

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“…Many pre-, peri-, and postoperative factors increase a patient's risk for developing these complications. Previous research has identified many of these risk factors including obesity, female gender, diabetes, history of smoking, disability, intraoperative blood loss, redo sternotomy, bilateral internal mammary artery grafting, prolonged mechanical ventilation, cardiopulmonary bypass, and surgical time [ 6 , 7 ]. In order to avoid many of the complications associated with median sternotomy, upper extremity (UE) activity limitations are prescribed to minimize postsurgical stress across the healing sternal halves [ 5 , 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy

LaPier

Cleary

2021

Applied Bionics and Biomechanics

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Patients often need to use their arms to assist with functional activities, but after open heart surgery, pushing with the arms is limited to <10 lb (4.5 kg) to help minimize force across the healing sternum. The main purposes of this study were to determine if older patients (>60 years old) (1) accurately estimated upper extremity (UE) weight bearing force of 10 lb or less and (2) if feedback training improved their ability to limit UE force and pectoralis major muscle contraction during functional activities. An instrumented walker was used to measure UE weight bearing force, and electromyography was used to measure pectoralis major muscle activity simultaneously during 4 functional mobility tasks. After baseline testing, healthy older subjects ( n = 30 ) completed a brief session of visual and auditory concurrent feedback training. Results showed that the self-selected UE force was >10 lb for all tasks (20.0-39.7 lb [9.1-18.0 kg]), but after feedback training, it was significantly reduced (10.6-21.3 lb [4.8-9.7 kg]). During most trials (92%), study participants used >12 lb (5.5 kg) of arm weight bearing force. Pectoralis major muscle peak electromyography activity was <23% of maximal voluntary isometric contraction and was reduced (9.8-14.9%) after feedback training. Older patients may not be able to accurately estimate UE arm force used during weight bearing activities, and visual and auditory feedback improves accuracy and also modulation of pectoralis major muscle activation. Results suggest that an instrumented walker and feedback training could be clinically useful for older patients recovering from open heart surgery.

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Section: Introductionmentioning

confidence: 99%

Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy

LaPier

Cleary

2021

Applied Bionics and Biomechanics

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“…Any intervention to reduce the burden of SWIs would, however, be of benefit if it were priced appropriately. Studies have shown that a single intervention can be effective at reducing infection rates, such as introducing 24-hour IV antibiotic prophylaxis, 36 local gentamicin sponges, 37 , 38 interlocking figure-eight and nitinol flexigrip closure, 36 , 39 , 40 and single-use ECG cables and leads. 26 , 34 Using equations provided in the methods section and our estimates of the SWI burden, providers can calculate how much they may pay on a per patient basis for implementing one or more of these interventions.…”

Section: Discussionmentioning

confidence: 99%

Sternal-Wound Infections following Coronary Artery Bypass Graft: Could Implementing Value-Based Purchasing be Beneficial?

Brandt

Blüher

Lankiewicz

et al. 2020

JHEOR

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Background/Objectives: Sternal-wound infections (SWIs) are rare but consequential healthcare-associated infections following coronary artery bypass graft surgery (CABG). The impact of SWIs on the cost of health care provision is unknown. The aim of this study was to quantify the burden of CABG-related SWIs across countries with mature health care systems and estimate value-based purchasing (VBP) levels based on the local burden. Methods: A structured literature review identified relevant data for 14 countries (the Netherlands, France, Germany, Austria, the United Kingdom, Canada, Italy, Japan, Spain, the United States, Brazil, Israel, Taiwan, and Thailand). Data, including SWI rates, CABG volume, and length of stay, were used to populate a previously published Markov model that simulates the patient’s CABG-care pathway and estimates the economic (US$) and care burden of SWIs for each country. Based on this burden, scenarios for VBP were explored for each country. A feasible cost of intervention per patient for an intervention providing a 20% reduction in the SWI rate was calculated. Results: The SWI burden varied considerably between settings, with SWIs occurring in 2.8% (the United Kingdom) to 10.4% (the Netherlands) of CABG procedures, while the costs per SWI varied between US$8172 (Brazil) to US$54 180 (Japan). Additional length of stay after SWI was the largest cost driver. The overall highest annual burden was identified in the United States (US$336 million) at a mean cost of US$36 769 per SWI. Given the SWI burden, the median cost of intervention per patient that a hospital could afford ranged from US$20 (US$13 to US$42) in France to US$111 (US$65 to US$183) in Japan. Conclusions: SWIs represent a large burden with a median cost of US$13 995 per case and US$900 per CABG procedure. By tackling SWIs, there is potential to simultaneously reduce the burden on health care systems and improve outcomes for patients. Mutually beneficial VBP agreements might be one method to promote uptake of novel methods of SWI prevention.

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“…28 Although alternative techniques for single-wire cerclage, such as double-wire, figure-of-8, and Robicsek's weave, have been developed to improve the relative distribution of compressive forces, 16,35 they have not been shown to reduce rates of sternal dehiscence or DSWI compared with single wires. 36,37 Furthermore, despite providing a range of compressive forces, none of these approaches address the biomechanical problem of inadequate fixation. 35 Rigid Fixation is especially critical in patients who are considered to be high risk because of morbid obesity, chronic obstructive pulmonary disease, diabetes mellitus, or other comorbidities, because sternal dehiscence is associated with a markedly higher mortality in these patients.…”

Section: Enhanced Recovery After Cardiac Surgerymentioning

confidence: 99%

Orthopedic Principles to Facilitate Enhanced Recovery After Cardiac Surgery

Gerdisch

Allen

Naka

et al. 2020

Critical Care Clinics

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Early patient mobilization is a major driver of recovery after cardiac surgery with open sternotomy. Instability of the healing sternal osteotomy hinders postoperative patient movement, causes pain, and puts patients at risk of complications, necessitating restrictive sternal precaution protocols. Sternal closure with wire cerclage does not adequately satisfy the three fundamental principles of orthopedic healing: approximation, compression, and rigid fixation. Selection of sternal closure methods according to orthopedic principles promotes accelerated recovery and return to normal activities while reducing pain and requirements for opioid analgesics.

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Prevention of deep sternal wound infection in cardiac surgery: a literature review

Cited by 58 publications

References 70 publications

Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy

Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy

Sternal-Wound Infections following Coronary Artery Bypass Graft: Could Implementing Value-Based Purchasing be Beneficial?

Orthopedic Principles to Facilitate Enhanced Recovery After Cardiac Surgery

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