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Xiphoid-sparing midline sternotomy reduces wound infection risk after coronary bypass surgery

Aref Rashed1, Zsofia Verzar2, Nasri Alotti1

  • 1Department of Cardiac Surgery, St. Rafael Zala County Hospital, Zalaegerszeg, Hungary.

Journal of Thoracic Disease
|August 3, 2018
PubMed
Abstract

Insights

Xiphoid process (XIP)-sparing midline sternotomy significantly reduces deep sternal wound infections (DSWIs) after coronary artery bypass grafting. This approach offers a safer alternative to traditional sternotomy for cardiac surgery patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Surgical Infection Prevention

Background:

  • Full midline sternotomy is standard for cardiac surgery but carries a risk of post-sternotomy wound infections.
  • Deep sternal wound infections (DSWIs) are a significant complication following sternotomy.
  • Evaluating alternative sternotomy techniques is crucial for improving patient outcomes.

Purpose of the Study:

  • To assess the efficacy of xiphoid process (XIP)-sparing midline sternotomy in reducing DSWIs.
  • To compare infection rates between XIP-sparing and traditional midline sternotomy.
  • To determine if XIP-sparing sternotomy is a viable alternative for coronary artery bypass grafting.

Main Methods:

  • Retrospective analysis of 446 coronary artery bypass grafting patients (2007-2017).
  • Comparison of preliminary (traditional sternotomy) and contemporary (XIP-sparing sternotomy) groups.
  • Application of inverse probability of treatment weighting (IPTW) for adjusting baseline characteristics.

Main Results:

  • XIP-sparing sternotomy group had a lower sternal infection rate (0.8%) compared to the standard sternotomy group (4.5%).
  • Adjusted analysis using IPTW showed a significantly decreased risk of DSWIs with XIP-sparing sternotomy (OR 0.171, P=0.026).

Conclusions:

  • XIP-sparing midline sternotomy appears to be a safe and effective alternative for coronary artery bypass surgery.
  • This technique shows potential in reducing the incidence of post-sternotomy wound infections.
  • Further research may support XIP-sparing sternotomy as a standard approach to minimize surgical site infections.
Keywords:
Coronary artery bypass surgerysternotomywound infectionxiphoid process (XIP)

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