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Eur J Cardiothorac Surg 2001;19:471-476
© 2001 Elsevier Science NL

Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables

^a Department of Thoracic and Cardiac Surgery, -414-, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
^b Department of Medical Informatics, Epidemiology and Statistics, -152-, University Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

Received 21 September 2000; received in revised form 9 January 2001; accepted 4 February 2001.

Corresponding author. Tel.: +31-24-3614744; fax: +31-24-3540129
e-mail: l.noyez{at}thchir.azn.nl

Objective: Select pre-, peri-, and post-operative variables, predictive for sternal wound complications (SWC), in a clinical setting. Methods: We analyzed pre-, peri-, and post-operative data of 3815 patients who underwent a primary isolated bypass grafting. 100 patients (2.6%) had post-operative SWC. Unifactor and multifactor risk analysis, were used for statistical analysis. Results: Unifactor analysis identified age (P=0.05), obesity (P=0.001), lung disease (P=0.001), extracorporeal circulation >100 min (P=0.02), graft choice (P=0.01), post-operative low cardiac output, reoperation, nephrological, pulmonary problems (P<0.001) as risk factors. Multifactor analysis, identified obesity (P=0.005), reoperation (P=0.01), nephrological (P=0.0001), pulmonary problems (P=0.001) and No-IMA-use (P=0.05) as independent predictors. Age <50 years (P=0.04) decreased the risk for SWC. There is, however, an interaction of the graft-use and the pre-operative and post-operative predictors, that can mask the precise effect of the graft-use. Conclusion: Reoperation, nephrological and pulmonary problems are strong predictors, obesity and age independent preoperative risk factors for sternal wound complications.

Key Words: Myocardial revascularization • Postoperative morbidity • Sternum • Wound complication

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