Reducing sternal Wound Infections After Cardiac Surgery Through Targeted, Interdisciplinary Efforts: A Large,
Alice V Vinogradsky1, Fady K Soliman1, Paul Kurlansky2
1Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York.
Background:
Sternal wound infections (SWIs) are associated with significant morbidity, mortality, and health care costs. After root-cause analysis, the study center implemented an evidence-based SWI prevention bundle and evaluated its effect on the SWI burden.
Methods:
Adult patients who underwent coronary artery bypass grafting or valve surgery, or both, through median sternotomy between 2021 and 2024 were reviewed (N = 2185). Patients were stratified by era (prebundle era vs postbundle era). Propensity score matching yielded 2 groups of 802 patients each. The primary outcome was deep SWI as defined by the National Healthcare Safety Network.
Results:
Matched groups were similar across key baseline variables. The SWI rate decreased from 2.7% in the prebundle era to 1.1% in the postbundle era (P = .03), driven by a 3-fold reduction in deep SWIs (2.1% vs 0.7%; P = .04). Superficial SWIs were unchanged (0.6% vs 0.3%; P = .87). Thirty-day readmissions also decreased (1.3% vs 0.4%; P = .01). Multivariable analysis identified diabetes, higher body mass index, and the prebundle era as predictors of SWI. A greater number and proportion of culture isolates were fungal in the postbundle era (33% vs 9.1%; P = .047).
Conclusions:
Implementation of an SWI prevention bundle significantly reduced deep SWIs and associated readmissions. The relative increase in fungal infections highlights the need for targeted strategies against Candida species.
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