Risk Factors for Deep Sternal Wound Infection after Off-Pump Coronary Artery Bypass Grafting: a Case-Control Study

Энгиноев, С. Т.; Rad, Arian Arjomandi; Екимов, С С; Kondrat'ev, Dmitry; Магомедов, Г. О.; Amirhanov, Alan; Tsaroev, B.S.; Ziankou, Alexander; Мотрева, А П; Чернов, И. И.; Тарасов, Д Г; Kadyraliev, Bakytbek

doi:10.21470/1678-9741-2020-0444

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…The rest 26 and seven variables were synthesized (Table 3 ). The dichotomous variables were diabetes mellitus (DM), 1 , 2 , 3 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 ,…”

Section: Resultsmentioning

confidence: 99%

“…The rest 26 and seven variables were synthesized (Table 3). The dichotomous variables were diabetes mellitus (DM), 1-3,8-21,23-32,34-54,56-66,68-79,103,106-109 female gender, 1-3,9-21,23,24,26-32,34,36-65,67-76,78-80,103-109 emergent/ urgent procedures, 1,3,10,13-17,20,21,23,27,28,30-32,35-38,41-44,48-51, 54-59,61-65,67,69-76,78-80,104-106 chronic obstructive pulmonary disease (COPD), 3,[8][9][10][13][14][15][16]18,20,21,23,25,[27][28][29][30][31][32][36][37][38][39][40][41][43][44][45][46][47][48][49]51,52,54,[57][58][59][61][62][63]67,[69][70][71]73,75,77,…”

Section: Investigated Variablesmentioning

confidence: 99%

“… 5 This leads to prolonged hospital stays, incremental charges and great suffering. 6 , 7 To determine its aetiology and minimize its incidence, we reviewed related studies and found that a large number of researches, 1 , 2 , 3 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 …”

Section: Introductionmentioning

confidence: 99%

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Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

Chen,

Zhang,

Wang

et al. 2023

International Wound Journal

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We aimed to quantitatively and systematically elucidate the rationality of the examined variables as independent risk factors for sternal wound infection. We searched databases to screen studies, ascertained the variables to be analysed, extracted the data and applied meta‐analysis to each qualified variable. Odds ratios and mean differences were considered to be the effect sizes for binary and continuous variables, respectively. A random‐effects model was used for these procedures. The source of heterogeneity was evaluated using a meta‐regression. Publication bias was tested by funnel plot and Egger's test, the significant results of which were then calculated using trim and fill analysis. We used a sensitivity analysis and bubble chart to describe their robustness. After screening all variables in the eligible literature, we excluded 55 because only one or no research found them significant after multivariate analysis, leaving 33 variables for synthesis. Two binary variables (age over 65 years, NYHA class >2) and a continuous variable (preoperative stay) were not significant after the meta‐analysis. The most robust independent risk factors in our study were diabetes mellitus, obesity, use of bilateral internal thoracic arteries, chronic obstructive pulmonary disease, prolonged surgery time, prolonged ventilation and critical preoperative state, followed by congestive heart failure, atrial fibrillation, renal insufficiency, stroke, peripheral vascular disease and use of an intra‐aortic balloon pump. Relatively low‐risk factors were emergent/urgent surgery, smoking, myocardial infarction, combined surgery and coronary artery bypass grafting. Sternal wound infection after open‐heart surgery is a multifactorial disease. The detected risk factors significantly affected the wound healing process, but some were different in strength. Anything that affects wound healing and antibacterial ability, such as lack of oxygen, local haemodynamic disorders, malnutrition condition and compromised immune system will increase the risk, and this reminds us of comprehensive treatment during the perioperative period.

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Section: Resultsmentioning

confidence: 99%

Section: Investigated Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

Chen,

Zhang,

Wang

et al. 2023

International Wound Journal

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“…Hyperglycemia impairs the immune system, thereby increasing the risk of infection and impeding normal wound healing [ 16 ]. The findings of related studies have been inconsistent [ 19 – 21 ]. Such heterogeneity could stem from multiple confounders, including patient demographics, HbA1c levels, and study design.…”

Section: Discussionmentioning

confidence: 99%

Association between HbA1c and deep sternal wound infection after coronary artery bypass: a systematic review and meta-analysis

Zhao,

Xie,

Zheng

et al. 2024

J Cardiothorac Surg

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Background Deep sternal wound infection (DSWI) constitutes a serious complication after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the dose-response relationship between glycated hemoglobin (HbA1c) level and the risk of DSWI after CABG. Methods PubMed, Scopus, and Cochrane Library databases were searched to identify potentially relevant articles. According to rigorous inclusion and exclusion criteria, fourteen studies including 15,570 patients were enrolled in our meta-analysis. Odds ratio (OR) with 95% confidence intervals (CIs) was used as the summary statistic. The robust-error meta-regression model was used to synthesize the dose-response relationship. Results Our meta-analysis shows that among patients undergoing CABG, preoperative elevated HbA1c was associated with the risk of developing DSWI (OR = 2.67, 95% CI 2.00–3.58) but with low prognostic accuracy (diagnostic OR = 2.70, 95% CI 1.96–3.73; area under the curve = 0.66, 95% CI 0.62–0.70) for predicting postoperative DSWI. Subgroup analyses showed the relationship became nonsignificant in patients without diabetes and studies adopting lower HbA1c thresholds. Dose-response analysis showed a significant nonlinear (p = 0.03) relationship between HbA1c and DSWI, with a significantly increased risk of DSWI when HbA1c was > 5.7%. Conclusions An elevated HbA1c level of > 5.7% was related to a higher risk of developing DSWI after CABG, and the risk increased as the HbA1c level grew. The association between HbA1c and DSWI was nonsignificant among nondiabetic patients while significant among diabetic patients.

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“…Moreover, it leads to reduced mortality and is a first-line treatment for bridging to sternal reconstruction [9]. The use of both internal thoracic arteries, excessive use of electrocoagulation and bone wax, diabetes mellitus, long cardio-pulmonary bypass (CPB) time, reoperation, and prolonged mechanical ventilation are associated with a higher incidence of DSWI after cardiac surgery [10,11]. However, differences between male and female patients with DSWI have not been fully examined in the last decades [12][13][14][15].…”

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confidence: 99%

Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery

Krasivskyi

Ivanov

Eghbalzadeh

et al. 2022

JCM

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Deep sternal wound infection (DSWI) is a feared complication after cardiac surgery. The impact of sex-related differences on wound infection prevalence is poorly understood. Our aim was to evaluate the effect of sex on short-term outcomes in patients with DSWI after open-heart surgery. The study was a retrospective cohort study. A total of 217 patients with DSWI were identified and retrospectively analyzed using our institutional database. Patients were divided into two groups: males (n = 150) and females (n = 67). This study also includes a propensity score based matching (PSM) analysis (male group (n = 62) and female group (n = 62)) to examine the unequal groups. Mean age (p = 0.088) and mean body mass index (BMI) (p = 0.905) did not significantly differ between both groups. Vacuum assisted closure (VAC) therapy was performed among most patients (82.3% (male group) vs. 83.9% (female group), p = 0.432). The most commonly isolated bacteria from the wounds were Staphylococcus epidermidis and Staphylococcus aureus in both groups. Acute renal failure was significantly higher (p = 0.010) in the male group compared to the female group. However, dialysis rate did not significantly differ (p = 0.491) between male and female groups. Further secondary outcomes showed no major differences between the groups. Likewise, in-hospital mortality rate did not differ significantly (p = 0.680) between both groups. Based on our data, sex has no impact on deep wound infection prevalence after cardiac surgery.

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Risk Factors for Deep Sternal Wound Infection after Off-Pump Coronary Artery Bypass Grafting: a Case-Control Study

Cited by 6 publications

References 20 publications

Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

Risk factors for sternal wound infection after open‐heart operations: A systematic review and meta‐analysis

Association between HbA1c and deep sternal wound infection after coronary artery bypass: a systematic review and meta-analysis

Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery

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