Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART

Abstract

Graphical Abstract OBJECTIVES Deep sternal wound infection (DSWI) is a serious complication after open-heart surgery. We investigated the association between DSWI and short- and long-term all-cause mortality in a large well-defined nationwide population. METHODS A retrospective, nationwide cohort study, which included 114 676 consecutive patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery from 1997 to 2015 in Sweden. Short- and long-term mortality was compared between DSWI patients and non-DSWI patients using propensity score inverse probability weighting adjustment based on patient characteristics and comorbidities. Median follow-up was 8.0 years (range 0–18.9). RESULTS Altogether, 1516 patients (1.3%) developed DSWI, most commonly in patients undergoing combined CABG and valve surgery (2.1%). DSWI patients were older and had more disease burden than non-DSWI patients. The unadjusted cumulative mortality was higher in the DSWI group compared with the non-DSWI group at 90 days (7.9% vs 3.0%, P < 0.001) and at 1 year (12.8% vs 4.5%, P < 0.001). The adjusted absolute difference in risk of death was 2.3% [95% confidence interval (CI): 0.8–3.9] at 90 days and 4.7% (95% CI: 2.6–6.7) at 1 year. DSWI was independently associated with 90-day [adjusted relative risk (aRR) 1.89 (95% CI: 1.38–2.59)], 1-year [aRR 2.13 (95% CI: 1.68–2.71)] and long-term all-cause mortality [adjusted hazard ratio 1.56 (95% CI: 1.30–1.88)]. CONCLUSIONS Both short- and long-term mortality risks are higher in DSWI patients compared to non-DSWI patients. These results stress the importance of preventing these infections and careful postoperative monitoring of DSWI patients.

Performance of a novel risk model for deep sternal wound infection after coronary artery bypass grafting

“…Although outcomes of cardiovascular surgery have improved over time, the incidence of deep sternal wound infection (DSWI) remains an important issue. Recently published data showed an incidence of DSWI ranging between 1.3 and 1.6% in patients undergoing CABG alone 1 , 2 . Morbidities associated with DSWI include prolonged hospital stays, increased use of antibiotics and consequent increased costs.…”

Analysis of Risk Factors for Sternal Wound Infection After Off-Pump Coronary Artery Bypass Grafting

“…Incision puncture (sternal puncture) might be feasible as an anti-infection diagnosis with no pus drainage.In cases with an unstable sternum, a chest CT might be useful for diagnosis and help detect the presence of deep infections, such as post-sternal soft tissue, loss of fat integrity, or post-sternal gas-containing abscesses without drainage. 19 Minor infections could usually be treated effectively with intravenous antibiotics, incision opening, and local dressing changes.Persistent sinus or multiple recurrent dehiscences might suggest the existence of deeper infection, often involving the sternal sutures, and secondary thoracotomy should be conducted instead of dressing changes.Removal of the metallic line, scraping the diseased bone, and six weeks of antibiotic treatment were effective for deep infections. In case of early exposure of the sternal metallic line or bone, the occurrence of SWI should be noted, and deep infection should be ruled out before dealing with the incision problem.…”

Coronary Artery Bypass Surgery After Transradial Catheterization

“…Medial hemorrhage and adventitial inflammation and fat necrosis are also seen more frequently in patients who underwent TRA. Although the 2021 CAD guidelines ( 3 ) recommend bilateral ITA grafting to improve long-term cardiovascular outcomes (Class 2a, LOE: B-nonrandomized), this benefit should be balanced by the increased risk of sternal wound complications, which are independently associated with worse long-term survival and whose risk is significantly increased with bilateral ITA grafting ( 10 , 11 ).…”