Deep sternal wound infections following coronary artery bypass graft surgery: risk factors and implications
Abstract number: o69
Paul M., Madar C., Raz E., Holinger R., Fraser A., Leibovici L., Rubinovitch B.
To assess the risk factors for Deep sternal wound infections (DSWIs) following coronary artery bypass graft (CABG), accounting for peri-operative glucose, oxygenation, and temperature control.
Prospective cohort study conducted in Rabin Medical Center, Israel including consecutive patients undergoing CABG during 2004. The dataset comprised of 154 peri-operative variables. Data were collected by daily chart review on ward using a case report form and merged with hospitals' electronic records. Continuous measurements of oxygen and temperature throughout surgery were included in the analysis. Follow-up for DSWIs was performed 60 days following surgery. DSWIs were defined by CDC criteria. Dichotomous variables were compared using a chi-square test; continuous variables were compared using nonparametric tests. A multivariate stepwise logistic regression model was constructed using variables found significant on univariate analysis (p < 0.05). Odds ratios (95% confidence intervals) are reported.
809 patients (79% male) undergoing CABG were included. CABG was elective in 31%. An additional operation, mostly valve replacement, was performed in 15%. Off-pump CABG was performed in 22%. Median patient age was 67 years (3191); 21% were above 75. Diabetes and chronic obstructive pulmonary disease (COPD) necessitating chronic therapy were present in 41% and 6% of patients, respectively. DSWIs occurred in 29 patients (3.6%). Variables independently associated with DSWIs included intra-operative glucose (OR 6.0, 1.326.5, for mean glucose > 140 mg/dl); COPD (OR 4.4, 1.413.7); and an operation additional to CABG (OR 3.3, 1.28.7). Haemoglobin A1C levels, hypothermia and post-operative hypoxemia were not significantly associated with DSWIs. The Euroscore was associated with DSWIs on univariate, but not with multivariate analysis. Post-operative hospital stay was longer among patients with DSWI compared to those without DSWI (median 31 vs. 5 days, respectively, p < 0.001). Thirty-day mortality was not significantly different with or without DSWI (0% vs. 5%, respectively), while 6 months mortality was significantly higher with DSWI (34.5% vs. 7.6%, p < 0.001).
DSWIs following CABG have grave implications. Modifiable risk factors include intra-operative glucose control and, potentially, COPD. Further studies should assess whether better preparation of COPD patients lowers DSWI rates.
|Session name:||XXIst ISTH Congress|
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