Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables

Noyez, Luc; Druten, J.A.M. van; Mulder, J. L.; Schroen, A.M.; Skotnicki, S.H.; Brouwer, René M.H.J.

doi:10.1016/s1010-7940(01)00610-8

Cited by 25 publications

(14 citation statements)

References 11 publications

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“…Reston et al [32] in a meta-analysis of 53 studies involving a total of 46 621 patients, found a lower incidence of wound complications, including superficial and deep infection in patients undergoing off-pump compared with on-pump CABG. The cardiopulmonary bypass time is a variable related to the duration of surgical procedure, and it was demonstrated as a possible risk predictor in some studies [33]. Although recognized in the literature as a possible risk factor, we observed no significant association between a prolonged cardiopulmonary bypass time and higher incidence of mediastinitis.…”

Section: Discussioncontrasting

confidence: 74%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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Section: Discussioncontrasting

confidence: 74%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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“…A previous study done by our group found that obesity is an independent preoperative risk factor for sternal wound complications after CABG [23]. This is in association with Lu et al and Schwann et al [24,15].…”

Section: Morbiditysupporting

confidence: 78%

“…A practical point in the discussion about sternal wound problems is the use of different sternal closing techniques. In this series, however, all patients' sternal closure was performed using twisted stainless steel wires and in our previous study we could not find a relation between techniques of sternal closure and sternal wound problems [23]. Another point is the influence of off-pump surgery (group A 2/30 (6.6%) versus 15/176 (8.5), group B 4/131 (3.0%) versus 37/793 (4.9%)).…”

Section: Morbiditymentioning

confidence: 54%

“…In our previous study, we concluded that there was an indication that BIMA use was an independent predictor of sternal wound problems. There is, however, an interaction of graft-use, pre-, and postoperative predictors, that mask the precise effect of the graft-use [23]. A practical point in the discussion about sternal wound problems is the use of different sternal closing techniques.…”

Section: Morbiditymentioning

confidence: 99%

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Influence of obesity on in-hospital and early mortality and morbidity after myocardial revascularization

Lindhout

Wouters

Noyez

2004

European Journal of Cardio-Thoracic Surgery

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Objective: Obese patients are thought to have an increased risk for complications in coronary artery bypass surgery. Several risk stratification systems do not identify obesity as a variable for risk adjustment. The aim of this study is to evaluate the in-hospital and early (one year) mortality and morbidity in obese and non-obese patients after a CABG in the UMC St Radboud. Methods: The data of 1130 patients undergoing a myocardial revascularization from January 2000 to August 2002 were analyzed. Obesity was measured by the body mass index (BMI). A BMI $ 30 kg/m 2 was defined as obese. We compared 206 obese patients with 924 non-obese patients. Uni-and multivariate analysis were used to analyze the results. The 1-year survival was analyzed using Kaplan -Meier methods. Results: There were no significant differences between obese and non-obese patients according to postoperative myocardial infarction, re-operation for bleeding, in-hospital mortality, renal complications, neurological complications, pulmonary complications, gastrointestinal complications, re-intubation, re-admission on intensive care, ventilation time, days on intensive care, days in hospital and late mortality. Only the incidence of postoperative wound infections was increased in obese patients, 8.3% in the obese versus 4.4% in the non-obese ðP ¼ 0:02Þ: Multivariate analysis identified obesity only as risk factor for postoperative for wound infections (P ¼ 0:04; odds ratio: 1.97). Conclusions: Obese patients do not have an increased risk of in-hospital and early (1 year) mortality after CABG. However, obese patients have an increased risk of postoperative wound infections compared to non-obese patients. q

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“…The cardiopulmonary bypass time is a variable related to the duration of surgical procedure, and it was demonstrated as a possible risk predictor in some of the studies [14]. However, the present study, in fact, does not establish such an observation as being the truth, once there were no control group CPB analyses (nonmediastinitis group) to compare with.…”

Section: Discussioncontrasting

confidence: 60%

Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

Sá¹,

Silva

Lima³

et al. 2010

Rev Bras Cir Cardiovasc

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Results: On average, complication occurred within 13 days after operation; in a total of 25 lethal cases (2.4%), deaths occurred in eight (32%). Several risk factors for mediastinitis were identified as follows: 56% diabetes, 56% smoking, 20% obesity, 16% chronic obstructive pulmonary disease, and 8% end-stage renal disease. Mediastinitis was reported in 21 (84%) patients submitted to coronary artery bypass grafting and it was related to a major risk for development of infection (IC 3.44-8.30, P=0.0001). High rates of complications were observed: respiratory failure (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%), and sternal dehiscence (48%). Bacterial cultures of exudates were positive in 84% of patients; Staphylococcus aureus was the most frequently pathogen (28.8%) detected.Conclusion: Mediastinitis remains as a severe surgical complication and difficult to manage in postoperative cardiovascular surgery. The disease has low incidence rate but high lethality. Coronary bypass was associated to a major risk for development of infection.Descriptors: Infection. Mediastinitis. Cardiac surgical procedures.

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Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables

Abstract: Reoperation, nephrological and pulmonary problems are strong predictors, obesity and age independent preoperative risk factors for sternal wound complications.

Cited by 25 publications

References 11 publications

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Influence of obesity on in-hospital and early mortality and morbidity after myocardial revascularization

Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

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