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

Objective: Select pre-, peri-, and post-operative variables, predictive for sternal wound complications (SWC), in a clinical setting. Methods: We anal yzed pre-, per-, and post-operative data of 3815 patients who underwent a p rimary isolated bypass grafting. 100 patients (2.6%) had post-operative SWC . Unifactor and multifactor risk analysis, were used for statistical analys is. Results: Unifactor analysis identified age (P = 0.05), obesity (P = 0.0 01), lung disease (p = 0.001), extracorporeal circulation > 100 min (P = 0. 02), graft choice (p = 0.01), post-operative low cardiac output, reoperatio n, nephrological, pulmonary problems (P < 0.001) as risk factors. Multifact or analysis, identified obesity (P = 0.005), reoperation (P = 0.001), nephr ological (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-op erative and post-operative predictors, that can mask the precise effect of the graft-use. Conclusion: Reoperation, nephrological and pulmonary problem s are strong predictors, obesity and age independent preoperative risk fact ors for sternal wound complications. (C) 2001 Elsevier Science B.V. All rig hts reserved.