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European Journal of Cardio-Thoracic Surgery, Vol 11, 1146-1153, Copyright © 1997 by European Association for Cardio-thoracic Surgery
E Stahle, A Tammelin, R Bergstrom, A Hambreus, SO Nystrom and HE Hansson
OBJECTIVE: Sternal wound complications, i.e. instability and/or infection
(mediastinitis), are important causes of morbidity in patients undergoing
cardiac surgery via median sternotomy. Coagulase negative staphylococci, a
normal inhabitant of the skin, have evolved as a cause of sternal wound
infections. Since these opportunistic pathogens often are multiresistant,
they can cause therapeutic problems. METHODS: From 1980 through 1995 open
heart surgery, was performed on 13,285 adult patients. Reoperation
necessitated by sternal wound complications occurerd in 203 patients
(1.5%). The incidence was 1.7% (168/9987) after coronary artery bypass
grafting (CABG group) and 0.7% (35/3413) after heart valve surgery with or
without concomitant CABG (HVR group). RESULTS: Factors independently
related to sternal complications in the CABG group (variable odds ratio
[95% C.I.]): year of surgery, 1.9 [1.3-2.8] in 1990-1992, 2.0 [1.4-2.9] in
1993-1995; female sex, 0.4 [0.2-0.6]; diabetic disease, 1.8 [1.2-2.5];
bilateral ITA procedure, 3.3 [1.1-7.7]; and postoperative dialysis, 3.1
[1.4- 6.9]. In the HVR group they were: use of ITA graft, 3.7 [1.7-7.7];
early re-exploration because of bleeding 3.0 [1.1-8.2]; and postoperative
dialysis 3.1, [1.4-9.3]. Multivariate models were used to compute the risk
for sternal complications in each patient. However, the prognostic models
based on these risk scores provided low sensitivity and low predictive
value. Patients with sternal wound complications showed no increased early
mortality but worse long-term survival even after adjustment for other
factors (relative hazard in CABG group 1.9 [1.2-2.8]; in HVR group 2.1
[1.1-4.3]. CONCLUSIONS: The use of ITA grafts seems to be one of the most
important factors related to sternal wound complications. However, patients
at truly increased risk for this complication could not be identified on
the basis of the risk factors considered in this study.
ARTICLES
Sternal wound complications--incidence, microbiology and risk factors
Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
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