Related Experiment Videos
Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors
R Wouters1, F Wellens, H Vanermen
1Department of Cardiovascular Surgery, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
Insights
This study identified key risk factors for sternitis and mediastinitis after coronary artery bypass grafting (CABG). Managing diabetes, smoking, and prolonged ventilation is crucial for preventing these serious infections post-CABG.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Epidemiology
Background:
- Sternitis and mediastinitis are serious complications following coronary artery bypass grafting (CABG).
- Identifying modifiable and non-modifiable risk factors is essential for improving patient outcomes and quality control in cardiac surgery.
Purpose of the Study:
- To analyze risk factors associated with the development of sternitis and mediastinitis after CABG.
- To evaluate the safety of using bilateral internal thoracic arteries in CABG procedures concerning infection risk.
Main Methods:
- Retrospective analysis of 1,368 consecutive CABG procedures performed between January 1990 and December 1991.
- Univariate and multivariate statistical analyses were employed to identify significant risk factors for sternitis and mediastinitis.
Main Results:
- The incidence of sternitis/mediastinitis was 1.7%, with a 30.4% mortality rate among affected patients.
- Independent risk factors identified include diabetes mellitus, recent smoking, reoperation, prolonged mechanical ventilation (>72 hours), and the presence of a specific surgical resident.
- Use of bilateral internal thoracic arteries was not an independent risk factor, but associated prolonged operating room time and reoperation may increase infection risk.
Conclusions:
- While bilateral internal thoracic artery use is not inherently risky, associated factors like extended operating times and reoperations warrant careful consideration.
- Selective use of this technique in high-risk patients is recommended.
- Close surveillance for wound infections is critical for identifying staff-related risk factors, such as Staphylococcus aureus dissemination.
Abstract:
As part of a quality control program, we analyzed possible risk factors in the development of sternitis and mediastinitis after coronary artery bypass grafting. From 1 January 1990 through 31 December 1991, 1,368 consecutive coronary artery bypass grafting procedures were performed at our institution, either alone or in combination with other procedures. Twenty-three patients (1.7%) developed sternitis and/or mediastinitis; 7 (30.4%) of these patients died in an early postoperative phase. Univariate analysis revealed the following statistically significant (p < or = 0.05) risk factors: perfusion time, length of stay in operating room of longer than 5 hours 30 minutes, presence at the operation of a certain surgical resident, revision for bleeding, and postoperative mechanical ventilation lasting longer than 72 hours. After multivariate analysis, statistically significant independent risk factors were: diabetes mellitus, recent cigarette-smoking, reoperation, presence of a certain surgical resident at the operation, revision for bleeding, and length of mechanical ventilation of longer than 72 hours. The use of both internal thoracic arteries was not, in this study, shown to be an independent risk factor. We conclude that although the technique of using both internal thoracic arteries for myocardial revascularization carries no extra risk by itself in the development of sternitis or mediastinitis, associated factors such as prolonged stay in the operating room and reoperation could be responsible for a higher frequency of sternitis-mediastinitis in patients who have undergone this procedure. Therefore, it is advisable to use this technique selectively in high-risk patients. Close surveillance and reporting of wound infections is mandatory to detect risk factor related to the surgical staff (such as Staphylococcus aureus dissemination).