National patterns in flap reconstruction for sternal wound infections following coronary artery bypass grafting

Sternal wound infection (SWI) is a serious and life-threatening complication of open cardiac surgery. Debridement and flap reconstruction has become standard of care, but data on national practice patterns are limited.

We queried the National Inpatient Sample from 2016-2018 for patients with SWI who underwent coronary artery bypass grafting (CABG). The outcomes of interest were reception of flap reconstruction and in-hospital mortality. Sociodemographic and clinical variables that differed significantly (p<0.20) on univariate analysis were incorporated into binary logistic regression (p<0.05).

In total, 120,440 patients who underwent CABG procedures were initially identified, of which 1399 (1.2%) were diagnosed with SWI. Among these SWI patients, 113 (8.1%) patients were treated with a flap procedure during their stay, and 134 (9.6%) patients died during admission. Female sex (odds ratio [OR]: 0.68, 95% confidence interval [CI]: 0.55-0.84, p<0.001) and rural (OR: 0.32, 95% CI: 0.13-0.79, p=0.013) or urban nonteaching (OR: 0.39, 95% CI: 0.27-0.56, p<0.001) hospital status predicted lower probability of flap reconstruction, whereas older age (OR: 1.028, 95% CI: 1.019-1.037, p<0.001) and higher comorbidity burden (OR: 1.026, 95% CI: 1.021-1.030, p<0.001) predicted higher risk of in-hospital mortality.

The rate of flap reconstruction is significantly lower than expected for management of SWI in some demographic groups. Our analysis highlights variations in practice patterns for SWI management depending on both patient demographics and hospital characteristics.