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Deep sternal wound infection after cardiac surgery
Hiroshi Kubota1, Hiroaki Miyata, Noboru Motomura
1Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, Japan. kub@ks.kyorin-u.ac.jp
Journal of Cardiothoracic Surgery
|May 22, 2013
Summary
Deep sternal wound infection (DSWI) after cardiac surgery occurred in 1.8% of cases. Re-exploration for bleeding significantly increased DSWI mortality, highlighting the need for effective prevention and treatment strategies.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Surgical Outcomes
Background:
- Deep sternal wound infection (DSWI) is a severe complication following cardiac surgery.
- Investigating DSWI incidence and the impact of re-exploration for bleeding on mortality is crucial.
Purpose of the Study:
- To determine the incidence of DSWI across various cardiac surgical procedures.
- To evaluate the effect of re-exploration for bleeding on DSWI-related mortality.
- To identify risk factors associated with DSWI and re-exploration for bleeding.
Main Methods:
- A retrospective review of 73,700 cardiac surgery cases from the Japan Adult Cardiovascular Surgery Database (2004-2009).
- Cases were categorized by surgical procedure (CABG, valve, thoracic aortic, and combined procedures).
- Incidence of DSWI, mortality rates (30-day and operative), and factors influencing outcomes were analyzed.
Main Results:
- The overall DSWI incidence was 1.8%, with higher rates in more complex procedures (e.g., 3.4% for thoracic aortic surgery plus CABG).
- Re-exploration for bleeding in DSWI cases (11.1% incidence) significantly increased 30-day/operative mortality (23.0%/48.0% vs. 8.1%/22.0%).
- Significant risk factors for DSWI included diabetes control and previous CABG; age, cardiogenic shock, and previous CABG were linked to re-exploration for bleeding.
Conclusions:
- DSWI incidence and mortality are associated with the complexity of cardiac surgery procedures.
- Re-exploration for bleeding following DSWI substantially elevates mortality rates.
- Improved DSWI prevention and treatment strategies are essential for better patient outcomes in cardiac surgery.
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