Related Experiment Video
Updated: Oct 5, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Association between sternal wound complications and 10-year mortality following coronary artery bypass grafting
Mario Gaudino1, Katia Audisio1, Mohamed Rahouma1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY.
Insights
Sternal wound complications (SWC) after cardiac surgery, though infrequent, significantly increase the risk of long-term mortality. Patients experiencing SWC faced higher rates of death and major adverse cardiovascular events.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes
- Public Health
Background:
- Sternal wound complications (SWC) are a known risk following cardiac surgery.
- Understanding the long-term impact of SWC on patient mortality is crucial for risk stratification and improved patient care.
Purpose of the Study:
- To evaluate the association between postoperative sternal wound complications (SWC) and long-term mortality.
- To identify predictors of SWC in patients undergoing coronary artery bypass grafting.
Main Methods:
- Analysis of participants from the Arterial Revascularization Trial.
- Stratification of patients based on the occurrence of postoperative SWC.
- Assessment of all-cause mortality and major adverse cardiovascular events as primary and secondary outcomes, respectively, with a median follow-up of 10 years.
Main Results:
- Of 3,102 patients, 115 (3.7%) experienced SWC (85 deep infections, 30 sterile).
- Independent predictors of SWC included diabetes, female sex, prior stroke, COPD, and bilateral internal thoracic artery use.
- SWC were significantly associated with increased long-term mortality (HR, 1.81; P<.001) and higher rates of major adverse cardiovascular events (44.3% vs 25.4%; P<.001).
Conclusions:
- Postoperative sternal wound complications (SWC), despite being uncommon, are independently associated with significantly increased long-term mortality.
- SWC also correlate with a higher incidence of major adverse cardiovascular events, underscoring their clinical importance.
Objective:
To evaluate the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial.
Methods:
Participants in the Arterial Revascularization Trial were stratified according to the occurrence of postoperative SWC. The primary outcome was all-cause mortality at long-term follow-up. The secondary outcome was major adverse cardiovascular events.
Results:
Three thousand one hundred two patients were included in the analysis; the median follow-up was 10 years. 115 patients (3.7%) had postoperative SWC: 85 (73.9%) deep sternal wound infections and 30 (26.1%) sterile SWC that required sternal reconstruction. Independent predictors of SWC included diabetes (odds ratio [OR], 2.77; 95% CI, 1.79-4.30; P < .001), female sex (OR, 2.73; 95% CI, 1.71-4.38; P < .001), prior stroke (OR, 2.59; 95% CI, 1.12-5.98; P = .03), chronic obstructive pulmonary disease (OR, 2.44; 95% CI, 1.60-3.71; P < .001), and use of bilateral internal thoracic artery (OR, 1.70; 95% CI, 1.12-2.59; P = .01). Postoperative SWC was significantly associated with long-term mortality. The Kaplan-Meier survival estimate was 91.3% at 5 years and 79.4% at 10 years in patients without SWC, and 86.1% and 64.3% in patients with SWC (log rank P < .001). The rate of major adverse cardiovascular events was also higher among patients who had SWC (n = 51 [44.3%] vs 758 [25.4%]; P < .001). Using multivariable analysis, the occurrence of SWC was independently associated with long-term mortality (hazard ratio, 1.81; 95% CI, 1.30-2.54; P < .001).
Conclusions:
In the Arterial Revascularization Trial, postoperative SWC although uncommon were significantly associated with long-term mortality.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Aneurysm III: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies