Does the time of resternotomy for bleeding have any influence on the incidence of sternal infections, septic courses or further complications?

Background: Former studies on sternal wound infections indicate predisposin g factors like diabetes, obesity, use of bilateral internal mammary grafts, impaired renal function and reoperation. We wanted to evaluate whether the time of resternotomy for postoperative bleeding has any influence on the d evelopment of a sternal wound infection and other complications. Methods: I n our department, 12,315 patients underwent median sternotomy for cardiac s urgery between 1987 and 1998. We analyzed the clinical data of all patients which were reoperated on for postoperative bleeding, especially patients w ith subsequent operations caused by sternal wound infections. All data were compared by T-test respectively X-2-test, and p<0.05 was regarded as signi ficant. Results: 406 of the 12,315 patients were re-explored because of pos toperative bleeding (3.3 %). 57 (14%) of these patients died in the postope rative period of non-infectious complications. The remaining patients were divided into two groups: Group A (286 patients) (70.4%) did not suffer from any sternal wound complications, where as group B patients (n = 63) (15.6% ) needed subsequent surgery due to sternal infection. There were no signifi cant differences in either concerning age, clinical data and first operatio n. All patients had an average blood loss of 223 ml/hr. The time before re- operation for bleeding was 5.3 +/- 1.7 hours in group A compared to 11.1 +/ - 4.2 hours in group B (p<0.05). A significant delay of reoperation for ble eding could also be found for patients with postoperative septic complicati ons (empty set: 5.2 +/- 1.9 hours, +: 12.9 +/- 5.2 hours), renal failure, m echanical ventilation >48 hours and a stay in hospital >20 days. Conclusion s: Early reoperation for postoperative bleeding decreases the number of sub sequent complications, e.g. sternal wound infections, septic complications and prolonged mechanical ventilation.