Postoperative Deep Sternal Wound Infection in CABG and Use of Bilateral Mammary Artery in Patients with Poor Diabetic Status

Background: Elevated glycated hemoglobin A1c (HbA1c) after coronary artery bypass grafting (CABG) is associated with an increased rate of wound infections (WIs). We evaluated the impact of HbA1c on the WI rate and the association of bilateral internal mammary artery (BIMA) use.

Method: Prospective data from patients after isolated CABG between January 2010 and August 2020 at our institution were analyzed. A total of 4,186 patients underwent isolated CABG during this period; of these, 3,229 patients with a preoperatively measured HbA1c were included in the study. We compared overall wound infections (WI), deep sternal wound infections (DSWI) and 30-day mortality as primary outcome as well as major adverse cardiac events (MACE) as secondary outcome between patients with a HbA1c higher or lower than 6.5%. In a subgroup analysis of patients with a poor diabetic status (HbA1c ≥ 6.5%) we compared the outcome parameters between those with and without BIMA grafts.

Results: WIs occurred in 114 patients (3.5%) and were more likely in patients with a preoperative HbA1c higher than 6.5% (5.6 vs. 2.8%, adjusted p = 0.002; OR: 1.835; 95% CI: 1.243–2.711). There was no difference in the incidence of DSWI or in 30-day mortality and other MACE between the two groups. The subgroup analysis of patients with a preoperative HbA1c ≥ 6.5% showed a significantly higher incidence of WI in patients with BIMA grafts (7.7 vs. 3.0%, adjusted, p = 0.002; OR: 4.766; 95% CI: 1.747–13.002). There was no difference with regards to microbial spectrum, the rate of antibiotic treatment, additional hospitalization days due to the wound infection or secondary outcome between patients with and without BIMA grafts.

Conclusion: The usage of BIMA in patients with poor diabetic status increases the overall incidence of wound infections but does not influence the incidence of deep sternal infections or 30-day mortality or MACE.

HbA1c ≥ 6.5%	No BIMA(n = 366)	BIMA(n = 456)	p-Value	Adjusted OR (95% CI)	Adjusted p-value
WI, n (%)	11 (3.0)	35 (7.7)	0.004	4.766 (1.747–13.002)	0.002
DSWI, n (%)	4 (1.1)	8 (1.9)	0.374	1.591 (0.260–9.749)	0.615
30-day hospital death, n (%)	11 (3.0)	6 (1.3)	0.091	1.689 (0.383–6.123)	0.489

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Artikel online veröffentlicht:
28. Januar 2023