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Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population
Christopher Doherty1, Duncan Nickerson1, Danielle A Southern2
1Section of Plastic Surgery, Department of Surgery, University of Calgary;
Insights
Despite an increasing number of sicker patients undergoing coronary artery bypass graft (CABG) surgery, the rate of sternal wound dehiscence remained stable. Key predictors for sternal wound dehiscence include diabetes, obesity, and female sex.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
- Public Health Epidemiology
Background:
- The demographic profile of patients undergoing coronary artery bypass graft (CABG) surgery has evolved, with potentially altered patient comorbidities.
- The impact of these demographic shifts on CABG-related outcomes, specifically sternal wound dehiscence, requires clarification.
Purpose of the Study:
- To determine the incidence and trends of sternal wound dehiscence following CABG.
- To quantify demographic changes in the CABG patient population.
- To identify patient-specific factors that predict the occurrence of sternal wound dehiscence.
Main Methods:
- A prospective analysis of a historical cohort of 5815 consecutive CABG patients in Alberta (2002-2009).
- Assessment of sternal wound dehiscence incidence and trends.
- Analysis of trends in comorbidity scores (Charlson index and EuroSCORE).
- Univariable and multivariable analyses to identify predictive factors for wound dehiscence.
Main Results:
- The incidence proportion of sternal wound dehiscence was 1.86%, with an incidence rate of 1.98 per 100 person-years.
- Despite a significant increase in patient comorbidity scores (Charlson and EuroSCORE), sternal wound dehiscence rates did not significantly change.
- Predictive factors for sternal wound dehiscence included diabetes (OR 2.97), obesity (OR 1.55), and female sex (OR 1.90).
Conclusions:
- The observed incidence of sternal wound dehiscence is consistent with previously reported literature.
- While CABG patients exhibit increasingly complex medical profiles, the incidence of sternal wound dehiscence has not significantly increased.
- Diabetes, obesity, and female sex are significant predictors of sternal wound dehiscence after CABG.
Background:
It appears that the medical profile of patients undergoing coronary artery bypass graft (CABG) surgery has changed. The impact of this demographic shift on CABG outcomes, such as sternal wound dehiscence, is unclear.
Objectives:
To quantify the incidence and trends of sternal wound dehiscence, quantify the demographic shift of those undergoing CABG and identify patient factors predictive of disease.
Methods:
A prospective analysis was performed on a historical cohort of consecutive patients who underwent CABG (without valve replacement) in Alberta between April 1, 2002 and November 30, 2009. The incidence and trends of sternal wound dehiscence were determined. In addition, the trend of the mean Charlson index score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) (capturing patient comorbidities) was analyzed. Univariable analysis and multivariable models were performed to determine factors predictive of wound dehiscence.
Results:
A total of 5815 patients underwent CABG during the study period. The incidence proportion of sternal wound dehiscence in Alberta was 1.86% and the incidence rate was 1.98 cases per 100 person-years. Although both the EuroSCORE and Charlson scores significantly increased over the study period, the incidence of sternal wound dehiscence did not change significantly. Factors predictive of sternal wound dehiscence were diabetes (OR 2.97 [95% CI 1.73 to 5.10]), obesity (OR 1.55 [95% CI 1.05 to 2.27]) and female sex (OR 1.90 [95% CI 1.26 to 2.87]).
Conclusions:
The incidence proportion of sternal wound dehiscence in Alberta was comparable with the incidence previously published in the literature. While patients undergoing CABG had worsening medical profiles, the incidence of sternal wound dehiscence did not appear to be increasing significantly.
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