DEEP STERNAL WOUND-INFECTION - RISK-FACTORS AND OUTCOMES

Background. Deep sternal wound infection (DSWI) is a serious complicat ion of cardiac operations performed by median sternotomy. We attempted to define the predictors of DSWI and to describe the outcomes of two treatment strategies used at our institution. Methods. Retrospective r eview was performed using prospectively gathered data on 12,267 consec utive cardiac surgical patients from 1990 to 1995. Chart review was pe rformed on all patients in whom DSWI developed, and follow-up was obta ined on 100% of these patients. Results. Deep sternal wound infections developed in 92 patients (incidence 0.75%). Multivariable predictors for development of DSWI in all patients were (odds ratios and 95% conf idence intervals in parentheses) (1) diabetes mellitus (2.6; 1.7 to 4. 0) and (2) male sex (2.2; 1.3 to 3.9). In patients receiving coronary artery bypass grafting alone, independent predictors were (1) bilatera l internal thoracic artery grafts (3.2; 1.1 to 8.9), (2) diabetes (2.7 ; 1.6 to 4.3), and (3) male sex (1.8; 0.9 to 3.7). For all other patie nts, predictors were (1) age more than 74 years (3.3; 1.1 to 10.1), (2 ) male sex (3.0; 1.1 to 8.1), and (3) diabetes (2.3; 0.9 to 5.8). Bila teral internal thoracic artery grafts increased the risk of DSWI in al l subgroups of coronary artery bypass graft patients, particularly in diabetics who had a 14.3% incidence of DSWI after bilateral internal t horacic artery grafting. Patients with DSWIs received either sternal d ebridement with primary closure (n = 45) or sternectomy with flap reco nstruction (n = 46). The 6-month freedom from adverse event rate (ie, readmission, reoperation, or death) was 76% for both groups of patient s. Conclusions. Male sex and diabetes are predictors of DSWI in all ca rdiac surgical patients. Bilateral internal thoracic artery grafting m ay be contraindicated in diabetic patients. (C) 1998 by The Society of Thoracic Surgeons.