Prevention of Poststernotomy Wound Infection by Application of Vancomycin Paste: A Retrospective Analysis

Background: Poststernotomy wound infection, including deep sternal wound infection (DSWI) and mediastinitis, is a severe complication after heart surgery with higher morbidity and mortality. This retrospective analysis determines the outcome of preventive intraoperative application of Vancomycin paste to the sternal edges in surgical revascularization.

Method: Between January 2010 and December 2021, a total of 4,934 patients underwent isolated surgical revascularization. Vancomycin (VCM) paste was used routinely since 2016. The retrospective evaluation compared two historical groups: after 2016 (VCM-group, n = 2,677) and before the application of vancomycin (Control group, n = 2,257). The early postoperative outcome, wound infection, or DSWI in long-term follow-up was retrospectively analyzed.

Results: Within the control group, a higher STS morbidity score (5.15 vs. 7.15; p = 0.001), a higher rate of extracardiac arteriopathy (16.2 vs. 22.4%; p ≤ 0,001) and a higher amount of re-do cases (0.7 vs. 1.8%; p < 0.001) were identified. In the VCM group, more patients suffered from an insulin-depending diabetes mellitus (6.7 vs. 1.6%; p < 0.001) or from obesity (BMI > 30, 29.8 vs. 27.1%; p = 0.040). Furthermore, there was a significant higher utilization of bilateral internal mammary arteries in the VCM group (63.3 vs. 55.9%; p < 0.001). But nonetheless, there is a marked reduction of wound-infections in the VCM group (3.0 vs. 4.1%; p = 0.035), whereas the rate of DSWI was just slightly lower and did not yield statistical significance (1.1 vs. 1.5%; p = 0.191). Mortality was comparable (1.6 vs. 1.6%; p = 0.910).

Conclusion: Applying Vancomycin paste before sternal closure lowers the risk of overall wound infections, despite higher risk factors like an insulin dependent diabetes or the use of bilateral internal mammary arteries for bypass grafting. The rate of deep sternal wound infections was not influenced, but the overall incidence has been extremely low in both cohorts.

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Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023