Risk Factors Associated with an Increased Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery

Abstract

Background: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. Methods: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher’s exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of < 0.05 was considered to be statistically significant. SPSS 26.0 was used for calculations. Results: Logistic regression analysis revealed that independent risk factors for sternal wound infection were high BMI (odds ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16), long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03), intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP concentration (OR 1.10; CI 1.05-1.16). Conclusions: Preoperative assessment to identify obese individuals as being at risk and techniques to minimize the duration of surgery and intraoperative blood loss may help reduce postoperative deep sternal wound infections.

A study on the preoperative risk factors for primary healing failure in the reconstruction of deep sternal wound infection with platelet‐rich plasma and negative pressure trauma therapy

“…Previous studies report age, gender, obesity, smoking history, and chronic cough caused by respiratory inflammation diseases, wound size, cable exposure, immune diseases, diabetes, hypertension, as risk factors for DSWI. [12][13][14][15] However, this retrospective study did not observe any significant independent effect of the aforementioned risk factors on the treatment outcome of the PRP + NPWT modality. Such results might be associated with the small sample size and the absence of continuous or dynamic tracking of the patients' general conditions, which will be the focus of our research in the next step.…”

“…However, in general, plastic surgeons contact DSWI patients late, and patients may not be healed for the first time as a result of the influence of various preoperative risk factors. [12][13][14][15] The purpose of this study is to explore and avoid the preoperative risk factors that affect the primary healing of DSWI patients treated with PRP + NPWT through retrospective analysis of previous cases. (2) Patients with a previous history of severe mental disease and those with malignant tumour who have undergone radiotherapy or chemotherapy.…”

The Effect of Birth Month on the Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery

“…In this model, variable such as age (years), sex, BMI, preoperative and postoperative CRB, duration of cardiopulmonary bypass, and anemia during the surgery as additional predictors were included. The results of previous work [Vitartaitė 2021] show that BMI, preoperative and postoperative CRP concentration, hemoglobin during surgery, and the duration of cardiopulmonary bypass were statistically significant factors for the risk of DSWI. We also analyzed the effect of MOB in patients' subgroups defined by age, sex, BMI, and the type of surgery.…”

“…According to the literature, risk factors include female sex, older age, diabetes, renal failure, obesity, chronic obstructive pulmonary disease, duration of surgery, reoperation because of bleeding, blood transfusion, prolonged ventilation, and postoperative vasopressor support. One study to identify the risk factors for postoperative development of deep sternal wound infection after coronary artery bypass grafting or heart defect surgery was performed at the Department of Thoracic, Cardiac and Vascular Surgery of Lithuanian University of Health Sciences [Vitartaitė 2021]. This study demonstrates that higher BMI, preoperative and postoperative CRP concentration, anemia, and the duration Collected data consisted of preoperative records that included gender, age, BMI, type of surgery, complete blood count (CBC) and biochemical blood test results, intraoperative data that included duration of surgery, duration of cardiopulmonary bypass, the need for catecholamines, diuretics, infusion therapy, blood loss, use of blood and blood products, CBC and biochemical blood test and blood gas results.…”

“…of cardiopulmonary bypass are independent risk factors for the development of postoperative deep sternal wound infections as in previous studies. The current study was designed to build on and extend the earlier study mentioned before to assess the effect of MOB on the risk of deep sternal wound infection occurrence for patients after coronary artery bypass grafting and other open-heart surgery.MATERIALS AND METHODSPatients: This research was a follow up to the retrospective study performed at the Department of Thoracic, Cardiac and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences[Vitartaitė 2021]. The case group consisted of the same 46 patients, who underwent reoperation because of DSWI.…”