Epidemiology of Deep Sternal Wound Infection in Cardiac Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2009-08, Vol.23 (4), p.488-494
• Main Authors: Filsoufi, Farzan, MD, Castillo, Javier G., MD, Rahmanian, Parwis B., MD, Broumand, Stafford R., MD, Silvay, George, MD, PhD, Carpentier, Alain, MD, PhD, Adams, David H., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; cardiac surgery; Cardiac Surgical Procedures - adverse effects; Coronary Artery Bypass - adverse effects; Critical Care; Female; Follow-Up Studies; Fungi; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; infection; Male; Middle Aged; Odds Ratio; outcomes; Retrospective Studies; Risk Factors; Sternum - surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; survival; Survival Analysis; Treatment Outcome
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2009.02.007

Objectives The aim of this study was to investigate the incidence and predictors of deep sternal wound infection (DSWI) in a contemporary cohort of patients undergoing cardiac surgery. The early and late outcomes of patients with this complication also were analyzed. Design A retrospective study of consecutive patients undergoing cardiac surgery using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively. Setting A university hospital (single institution). Participants Five thousand seven hundred ninety-eight patients who underwent cardiac surgery between January 1998 and December 2005 including isolated coronary artery bypass graft (CABG) (n = 2,749, 47%), single- or multiple-valve surgery (n = 1,280, 22%), combined valve and CABG procedures (n = 934, 16%), and surgery involving the ascending aorta or the aortic arch (n = 835, 15%). Interventions None. Measurements and Main Results The overall incidence of DSWI was 1.8% (n = 106). The highest rate of DSWI occurred after combined valve/CABG surgery (2.4%, n = 22) and aortic procedures (2.4%, n = 19). Multivariate analysis revealed 11 predictors of DSWI: obesity (odds ratio [OR] = 2.2), previous myocardial infarction (OR = 2.1), diabetes (OR = 1.7), chronic obstructive pulmonary disease (OR = 2.3), preoperative length of stay >3 days (OR = 1.9), aortic calcification (OR = 2.7), aortic surgery (OR = 2.4), combined valve/CABG procedures (OR = 1.9), cardiopulmonary bypass time (OR = 1.8), re-exploration for bleeding (OR = 6.3), and respiratory failure (OR = 3.2). The mortality rate was 14.2% (n = 15) versus 3.6% (n = 205) in the control group ( p < 0.001). One- and 5-year survival after DSWI were significantly decreased (72.4% ± 4.4% and 55.8% ± 5.6% v 93.8% ± 0.3% and 82.0% ± 0.6%, p < 0.001). Conclusion DSWI remains a rare but devastating complication and is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival.