Risk factors for sternal wound infection after various cardiac operations_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Jun , XUAN Yilong ,  WANG Dongjing

Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;

Corresponding author：

WANG Dongjing, Email: gldjw@163.com

Keywords：

Sternal wound infection; cardiac operation; risk factor

DOI：

10.7507/1007-4848.201605030

Video：

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Objective To evaluate the risk factors for sternal wound infections after various cardiac operations. Methods We retrospectively analyzed the clinical data of 2 924 consecutive patients (28% female) in our hospital from 2010 to 2014 year. Their median age was 69 years (interquartile range of 60 to 76 years). Procedures included isolated coronary artery bypass grafting (CABG), isolated valve repair or replacement, and valve procedures plus CABG. Results Sternal wound infection was detected in 110 (3.8%) patients among the 2 924 patients: 67 of 1 671 patients (4.0%) after CABG, 17 of 719 (2.4%) after valve operations, and 26 of 534 (4.9%) after valve+CABG operation. In the CABG patients, bilateral internal thoracic artery harvest procedure, operation time>300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female were independent risk factors for sternal wound infection. In the valve operation patients, only revision for bleeding as an independent predictor for sternal infection. For combined valve plus CABG patients, revision for bleeding and operation time>300 minutes were independent risk factors for sternal infection. Conclusion Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, operation time) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female) are predictors of sternal wound infection. Preventive interventions may be justified according to the type of operation.

Citation： PAN Jun, XUAN Yilong, WANG Dongjing. Risk factors for sternal wound infection after various cardiac operations. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 281-284. doi: 10.7507/1007-4848.201605030 Copy

1.	Blanchard A, Hurni M, Ruchat P. Incidence of deep and superficial sternal infections after open heart surgery: a ten years retrospective study from 1981 to 1991. Eur J Cardiothorac Surg, 1995, 9(3): 153-157.
2.	Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt), 2013, 14(1): 73-156.
3.	Wang FD, Chang CH. Risk factors of deep sternal wound infections in coronary artery bypass graft surgery. J Cardiovasc Surg (Torino), 2010, 41(5): 709-713.
4.	Gummert JF, Barten MJ, Hans C, et al. Mediastinitis and cardiac surgery–an updated risk factor analysis in 10 373 consecutive adult patients. Thorac Cardiovasc Surg, 2002, 50(2): 87-91.
5.	Braxton HJ, Marrin CA, McGrath PD, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg, 2004, 16(1): 70-76.
6.	Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg, 2004, 77(2): 676-683.
7.	Fleck TM, Koller R, Giovanolli P, et al. Primary or delayed closure for the treatment of post-sternotomy wound infections? Ann Plast Surg, 2004, 52(3): 310-314.
8.	Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg, 2012, 41(4): 734-744.
9.	El Oakley RM, Wright JE. Postoperative mediastinitis:classification and management. Ann Thorac Surg, 1996, 61(3): 1030-1036.
10.	Nashef SA, Roques F, Michel P. European system for cardiac operative risk evaluation. Eur J Cardiothorac Surg, 1999, 16(1): 9-13.
11.	Mannien J, Wille CJ, Kloek JJ. Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands. J Thorac Cardiovasc Surg, 2011, 141(4): 899-904.
12.	Junoz P, Menasalvas A, Bernaldo de Quiros JC. Postsurgical mediastinitis: a case-control study. Clin Infect Dis, 1997, 25(2): 1060-1064.
13.	Andreas M, Zeitlinger M, Hoeferl M, et al. Internal mammary artery harvesting influences antibiotic penetration into presternal tissue. Ann Thorac Surg, 2013, 95(4): 1323-1329.
14.	Chen LF, Anderson DJ, Kaye KS. Validating a 3-point prediction rule for surgical site infection after coronary artery bypass surgery. Infect Control Hosp Epidemiol, 2010, 31(1): 64-68.
15.	Milano CA, Kesler K, Archibald N. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation, 1995, 92(8): 2245-2251.
16.	Lador A, Nasir H, Mansur N, et al. Antibiotic prophylaxis in cardiac surgery: systematic review and meta-analysis. J Antimicrob Chemother, 2012, 67(3): 541-550.
17.	Kapeller R, Gillham M, Brown NM. Antibiotic prophylaxis for cardiac surgery. J Antimicrob Chemother, 2012, 67(3): 521-522.
18.	Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery–microbiology and pathogenesis. Eur J Cardiothorac Surg, 2002, 21(5): 825-830.
19.	Sjoogren J, Malmsjoo M, Gustafsson R, et al. Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg, 2006, 30(6): 898-905.
20.	Robicsek F, Fokin A, Cook J, et al. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg, 2000, 48(1): 1-8.

1. Blanchard A, Hurni M, Ruchat P. Incidence of deep and superficial sternal infections after open heart surgery: a ten years retrospective study from 1981 to 1991. Eur J Cardiothorac Surg, 1995, 9(3): 153-157.
2. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt), 2013, 14(1): 73-156.
3. Wang FD, Chang CH. Risk factors of deep sternal wound infections in coronary artery bypass graft surgery. J Cardiovasc Surg (Torino), 2010, 41(5): 709-713.
4. Gummert JF, Barten MJ, Hans C, et al. Mediastinitis and cardiac surgery–an updated risk factor analysis in 10 373 consecutive adult patients. Thorac Cardiovasc Surg, 2002, 50(2): 87-91.
5. Braxton HJ, Marrin CA, McGrath PD, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg, 2004, 16(1): 70-76.
6. Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg, 2004, 77(2): 676-683.
7. Fleck TM, Koller R, Giovanolli P, et al. Primary or delayed closure for the treatment of post-sternotomy wound infections? Ann Plast Surg, 2004, 52(3): 310-314.
8. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg, 2012, 41(4): 734-744.
9. El Oakley RM, Wright JE. Postoperative mediastinitis:classification and management. Ann Thorac Surg, 1996, 61(3): 1030-1036.
10. Nashef SA, Roques F, Michel P. European system for cardiac operative risk evaluation. Eur J Cardiothorac Surg, 1999, 16(1): 9-13.
11. Mannien J, Wille CJ, Kloek JJ. Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands. J Thorac Cardiovasc Surg, 2011, 141(4): 899-904.
12. Junoz P, Menasalvas A, Bernaldo de Quiros JC. Postsurgical mediastinitis: a case-control study. Clin Infect Dis, 1997, 25(2): 1060-1064.
13. Andreas M, Zeitlinger M, Hoeferl M, et al. Internal mammary artery harvesting influences antibiotic penetration into presternal tissue. Ann Thorac Surg, 2013, 95(4): 1323-1329.
14. Chen LF, Anderson DJ, Kaye KS. Validating a 3-point prediction rule for surgical site infection after coronary artery bypass surgery. Infect Control Hosp Epidemiol, 2010, 31(1): 64-68.
15. Milano CA, Kesler K, Archibald N. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation, 1995, 92(8): 2245-2251.
16. Lador A, Nasir H, Mansur N, et al. Antibiotic prophylaxis in cardiac surgery: systematic review and meta-analysis. J Antimicrob Chemother, 2012, 67(3): 541-550.
17. Kapeller R, Gillham M, Brown NM. Antibiotic prophylaxis for cardiac surgery. J Antimicrob Chemother, 2012, 67(3): 521-522.
18. Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery–microbiology and pathogenesis. Eur J Cardiothorac Surg, 2002, 21(5): 825-830.
19. Sjoogren J, Malmsjoo M, Gustafsson R, et al. Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg, 2006, 30(6): 898-905.
20. Robicsek F, Fokin A, Cook J, et al. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg, 2000, 48(1): 1-8.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for sternal wound infection after various cardiac operations

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