Back

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.

Objectives: 

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.

Methods: 

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.

Results: 

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 (31–91); 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, 1.3–26.5, for mean glucose > 140 mg/dl); COPD (OR 4.4, 1.4–13.7); and an operation additional to CABG (OR 3.3, 1.2–8.7). 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).

Conclusion: 

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 Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
Back to top