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Published on: September 15, 2023
Impact of Deep Sternal Wound Infection on Long-Term Survival Based on Revascularisation Strategy: Results From the
Sleiman Sebastian Aboul-Hassan1, Grzegorz Hirnle2, Bartlomiej Perek3
1Department of Cardiac Surgery, Zbigniew Religa Heart Center "Medinet", Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland.
Insights
Deep sternal wound infection (DSWI) negatively impacts long-term survival in coronary artery bypass grafting (CABG) patients, regardless of whether multiple arterial grafting (MAG) or single artery with saphenous vein grafts (SAG) were used. The benefits of MAG diminish if DSWI occurs.
Area of Science:
- Cardiovascular Surgery
- Surgical Infections
- Grafting Techniques
Background:
- Deep sternal wound infection (DSWI) is a serious complication after coronary artery bypass grafting (CABG).
- The choice between multiple arterial grafting (MAG) and single artery with saphenous vein grafts (SAG) impacts patient outcomes.
- The interplay between grafting strategy and DSWI on long-term survival requires investigation.
Purpose of the Study:
- To evaluate the effect of DSWI on long-term survival in CABG patients.
- To compare outcomes between MAG and SAG in the presence or absence of DSWI.
- To determine if DSWI negates the potential survival benefits of MAG over SAG.
Main Methods:
- A multicentre study utilizing the Polish National Registry of Cardiac Surgery Procedures database.
- Inclusion of 81,136 patients undergoing CABG for multivessel disease between 2012 and 2020.
- Application of inverse probability of treatment weighting (IPTW) to adjust for baseline differences between groups.
Main Results:
- DSWI was associated with reduced long-term survival in both MAG and SAG groups (HR 1.89 and 1.92, respectively; p<0.01).
- In the absence of DSWI, MAG demonstrated improved long-term survival compared to SAG (HR 0.68; p<0.01).
- Patients with MAG and DSWI had similar long-term survival to those with SAG without DSWI (HR 1.31; p=0.63).
Conclusions:
- DSWI significantly worsens long-term survival for patients undergoing CABG, irrespective of the grafting method (MAG or SAG).
- The survival advantage of MAG over SAG is significantly diminished or eliminated in the presence of DSWI.
- DSWI is a critical factor influencing long-term outcomes in CABG patients, underscoring the importance of infection prevention.
Background:
This multicentre study aimed to investigate the impact of deep sternal wound infection (DSWI) on long-term survival among patients undergoing coronary artery bypass grafting (CABG) using multiple arterial grafting (MAG) or single artery with saphenous vein grafts (SAG).
Methods:
Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. Between January 2012 and December 2020, 81,136 patients who underwent CABG for multivessel disease were included in the study. Patients were divided into four groups: MAG with DSWI (n=219), MAG without DSWI (n=8,611), SAG with DSWI (n=1,432), and SAG without DSWI (n=70,874). Inverse probability of treatment weighting based on the generalised propensity score was used to minimise imbalance between the groups.
Results:
In the weighted sample, DSWI in patients who received MAG was associated with reduced long-term survival when compared with patients without DSWI and MAG (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.29-2.78; Bonferroni corrected p=0.01). Deep sternal wound infection in patients who received SAG was associated with reduced long-term survival when compared with patients without DSWI and SAG (HR 1.92, 95% CI 1.69-2.17; Bonferroni corrected p=0.01). In patients who did not develop DSWI, MAG was associated with improved long-term survival compared with SAG (HR 0.68, 95% CI 0.63-0.74; Bonferroni corrected p=0.01). However, patients who received MAG and developed DSWI had similar long-term survival when compared with patients who received SAG and did not develop DSWI (HR 1.31, 95% CI 0.90-1.92; Bonferroni corrected p=0.63). A landmark analysis excluding the first 6 months of follow-up was performed to exclude the risk of acute mortality due to DSWI. In the weighted sample, the results were consistent with the main analysis.
Conclusion:
Deep sternal wound infection is associated with worse survival in patients receiving MAG and SAG. Moreover, the superior effect of MAG over SAG diminishes once DSWI develops.
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