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A cluster of sternal wound infections requiring muscle flap repair: problems in epidemiologic investigation
G A Gellert1, S M Gordon, R S Gordon
1Orange County Health Care Agency, Santa Ana, CA.
Abstract:
A cluster of sternal wound infections (SWI) requiring muscle flap closure occurred in a California hospital in 1988. Review of SWI rates by surgical team revealed that a single team (Team A) was associated with a cluster of SWI requiring muscle flap repair (MFR). Team A's rate of SWI requiring MFR was 2.27% in 441 heart operations. A case/control study was conducted to determine if the higher rate of SWI requiring MFR could be attributed to disproportionately large numbers of patients at high risk treated by Team A. Data on major risk factors for SWI collected for case and control groups included the following: age at operation, weight, body surface area, history of obesity, diabetes mellitus, or cigarette smoking, duration of cardiopulmonary bypass, use of internal mammary artery graft, number of coronary arteries bypassed, use of prostheses, operating room staffing, and emergent nature of operation. No statistically significant differences between Team A cases requiring MFR and control cases were observed for predisposing risk factors. Surgical technique remains a principal suspected risk factor for SWI requiring MFR in this cluster.
Insights
A cluster of sternal wound infections (SWI) requiring muscle flap repair (MFR) was linked to a specific surgical team. Patient risk factors did not explain the higher MFR rate, suggesting surgical technique may be the cause.
Area of Science:
- Medical research
- Surgical outcomes
- Infectious disease epidemiology
Background:
- A cluster of sternal wound infections (SWI) requiring muscle flap repair (MFR) was identified in a California hospital in 1988.
- A specific surgical team (Team A) showed a significantly higher rate of SWI requiring MFR (2.27%) compared to other teams.
Purpose of the Study:
- To investigate the cause of the elevated SWI requiring MFR rate associated with Team A.
- To determine if patient-specific risk factors disproportionately affected by Team A contributed to the observed cluster of infections.
Main Methods:
- A case/control study design was employed.
- Data on multiple predisposing risk factors for SWI were collected and compared between cases requiring MFR and control cases.
- Risk factors analyzed included patient demographics, comorbidities, and surgical procedure characteristics.
Main Results:
- No statistically significant differences in predisposing risk factors were found between Team A cases requiring MFR and control cases.
- The higher rate of SWI requiring MFR in Team A was not attributable to treating a higher proportion of high-risk patients.
Conclusions:
- The study suggests that patient risk factors do not explain the cluster of SWI requiring MFR.
- Surgical technique employed by Team A is identified as the principal suspected risk factor for the observed increase in sternal wound infections requiring muscle flap repair.
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