Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting

Objective: Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital. M ethods: We compared the prevalence of deep sternal site infection among pat ients having coronary artery bypass grafting during the study (January 1995 -March 1998) and pre-study (January 1992-December 1994) periods. We compare d any patient having a deep sternal site infection after coronary artery by pass graft surgery during the study period (case-patients) with randomly se lected patients who had coronary artery bypass graft surgery but no deep st ernal site infection during the same period (control-patients), Results: De ep sternal site infections were significantly more common during the study than during the pre-study period (30/1796 [1.7%] vs 9/1232 [0.7%]; P =.04). Among 30 case-patients, 29 (97%) returned to the operating room for sterna l debridement or rewiring, and 2 (7%) died. In multivariable analyses, cefu roxime receipt 2 hours or more before incision (odds ratio = 5.0), diabetes mellitus with a preoperative blood glucose level of 200 mg/dL or more (odd s ratio = 10.2), and staple use for skin closure (odds ratio = 4.0) were in dependent risk factors for deep sternal site infection. Staple use was a ri sk factor only for patients with a normal body mass index. Conclusions: App ropriate timing of antimicrobial prophylaxis, control of preoperative blood glucose levels, and avoidance of staple use in patients with a normal body mass index should prevent deep sternal site infection after coronary arter y bypass graft operations.