Thorac Cardiovasc Surg 2013; 61 - OP248
DOI: 10.1055/s-0032-1332487

Risk factors for deep sternal wound infection following open-heart surgery – depending on indication?

K Meszaros 1, 2, S Grogg 1, K Mühlemann 3, G Sodeck 4, L Englberger 1, D Reineke 1, F Schönhoff 1, J Schmidli 1, M Czerny 1, T Carrel 1
  • 1University Hospital Bern, Department for Cardiovascular Surgery, Bern, Switzerland
  • 2Medical University of Graz, Department for Cardiac Surgery, Graz, Austria
  • 3University of Bern, Institute for Infectious Diseases, Bern, Switzerland
  • 4Medical University of Vienna, Department for Emergency Medicine, Wien, Austria

Objective: To identify risk factors for deep sternal wound infections following open-heart surgery for different indications.

Methods: University center audit of 4.661 consecutive patients (median age 68 years – interquartile range (IQR) 59 – 75; 28% female sex, median additive EUROScore 6, IQR 4 – 9) following CABG, single-valve or combined surgery between 2006 and 2010. An institutional database was interrogated for incidence and identification of individual risk factors. Univariate and multivariate binary logistic regression analysis were performed to identify independent predictors for deep sternal wound infections.

Results: We recorded a total of 107 cases of deep sternal wound infections (2.3%): 67 out of 1.881 patients after CABG (3.6%), 13 patients out of 984 (1.3%) following valve surgery and 27 out of 1.796 patients (1.5%) after combined procedure. The presence of a deep sternal infection increased significantly 30-mortality: 6.5% vs. 2.7%; P = 0.03 (CABG 7.5% vs. 1.0%, valve surgery 7.7% vs. 2.1%, combined procedure 4.7% vs. 3.7%).

In the CABG cohort multivariate regression analysis revealed chronic renal failure (OR 6.5 95% CI 3.5 – 11.9) and redo-surgery (OR 6.0 95% CI 2.2 – 16.8) as strongest independent risk factors for occurrence whereas for patients following valve surgery emergency surgery (OR 26 95% CI 6.9 – 101) and reoperation for bleeding complications (OR 22 95% CI 5.1 – 98) could be identified. Chronic renal failure (OR 7.6 95% CI 3.2 – 18.2) and LIMA usage (OR 11.9 95% CI 3.7 – 38) were the strongest independent risk factors in patients undergoing combined procedure.

Conclusion: The underlying pathology and subsequent surgical intervention modify risk profiles for the development of deep sternal wound infections following open heart surgery: Whereas chronic renal failure plays an independent role in CABG patients and patients undergoing combined procedures, an emergency setting is strongly associated with a higher risk for development of sternal wound infection in valve-only patients.