Risk factors for sternal wound infection after median sternotomy: A nested case-control study and time-to-event...

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Medical Informatics

Background:

• Sternal wound infection (SWI) is a serious complication following median sternotomy.
• While risk factors for SWI are known, the onset time and differing contributors for superficial SWI (SSWI) and deep SWI (DSWI) remain less understood.

Purpose of the Study:

• To compare the onset time and identify distinct risk factors for superficial and deep SWI.
• To develop a predictive model for SWI risk.

Main Methods:

• A nested case-control study involving adult patients undergoing cardiac surgery via median sternotomy.
• Analysis included Kaplan-Meier, LASSO, and Cox regression models.
• A nomogram was developed for SWI risk prediction.

Main Results:

• The incidence of SWI was 1.1%. The median onset time for SWI was 35 days, with DSWI having a longer latency (46 days) than SSWI (32 days).
• Independent risk factors for overall SWI included BMI, diabetes mellitus (DM), and myocardial infarction (MI).
• SSWI was associated with BMI, while DSWI was linked to DM and longer surgery duration. The SWI prediction nomogram demonstrated fair performance (AUC 0.67).

Conclusions:

• BMI, DM, and MI are significant independent risk factors for SWI after cardiac surgery.
• Superficial and deep SWI exhibit different onset times and associated risk factors, necessitating tailored management strategies.
• The developed nomogram offers a useful tool for clinical prediction of SWI risk.