Surgical Site Infection after Sternotomy in Low- and Middle-Human Development Index Countries: A Systematic Review
Joseph D Forrester1, Lawrence Z Cai2, Sanford Zeigler3
11 Department of General Surgery, Stanford University , Stanford, California.
Insights
Surgical site infections (SSIs) after sternotomy in low- and middle-human development index (LMHDI) countries occur at a rate of 4.3 per 100 procedures. This rate is comparable to high-human development index countries, highlighting the need for safe cardiac surgical care.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Epidemiology
- Global Health
Background:
- Cardiovascular disease burden is rising in low- and middle-human development index (LMHDI) countries.
- Cardiac operations are crucial for cardiovascular care.
- Baseline surgical site infection (SSI) data for sternotomy in LMHDI settings is lacking.
Purpose of the Study:
- To determine the incidence of SSIs after sternotomy in LMHDI countries.
- To establish baseline expectations for SSI rates in LMHDI cardiac surgery programs.
Main Methods:
- Systematic literature review of PubMed, Ovid, and Web of Science databases.
- Inclusion of prospectively registered studies on sternotomy SSIs in LMHDI countries.
- Quantitative synthesis of sternotomy SSI rates for coronary artery bypass grafting (CABG) patients.
Main Results:
- 14 studies were reviewed from 423 identified abstracts.
- The pooled SSI rate after sternotomy was 4.3 per 100 sternotomies (95% CI 1.3-6.0).
- This rate is comparable to those reported in high-human development index countries.
Conclusions:
- Safe cardiac surgical care is essential as cardiovascular disease increases in LMHDI settings.
- Establishing baseline SSI rates is a critical first step for improving cardiac surgical programs in LMHDI countries.
Background:
The burden of cardiovascular disease is increasing in low- and middle-human development index (LMHDI) countries, and cardiac operations are an important component of a comprehensive cardiovascular care package. Little is known about the baseline incidence of surgical site infections (SSIs) among patients undergoing sternotomy in LMHDI countries.
Methods:
A prospectively registered, systematic literature review of articles in the PubMed, Ovid, and Web of Science databases describing the epidemiology and management of SSIs among persons undergoing sternotomy in LMHDI countries was performed. We performed a quantitative synthesis of patients undergoing sternotomy for CABG to estimate published sternotomy SSI rates.
Results:
Of the 423 abstracts identified after applying search criteria, 14 studies were reviewed in detail. The pooled SSI rate after sternotomy among reviewed studies was 4.3 infections per 100 sternotomies (95% confidence interval [CI] 1.3-6.0 infections per 100 sternotomies), which is comparable to infection rates in high-human development index countries.
Conclusions:
As the burden of cardiovascular disease in LMHDI settings increases, the ability to provide safe cardiac surgical care is paramount. Describing the baseline SSI rate after sternotomy in LMHDI countries is an important first step in creating baseline expectations for SSI rates in cardiac surgical programs in these settings.
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