A cluster of sternal wound infections requiring muscle flap repair: problems in epidemiologic investigation.
A cluster of sternal wound infections (SWI) requiring muscle flap closure occurred in a California hospital in 1988. Review of SWI rates by surgical team revealed that a single team (Team A) was associated with a cluster of SWI requiring muscle flap repair (MFR). Team A's rate of SWI requiring MFR was 2.27% in 441 heart operations. A case/control study was conducted to determine if the higher rate of SWI requiring MFR could be attributed to disproportionately large numbers of patients at high risk treated by Team A. Data on major risk factors for SWI collected for case and control groups included the following: age at operation, weight, body surface area, history of obesity, diabetes mellitus, or cigarette smoking, duration of cardiopulmonary bypass, use of internal mammary artery graft, number of coronary arteries bypassed, use of prostheses, operating room staffing, and emergent nature of operation. No statistically significant differences between Team A cases requiring MFR and control cases were observed for predisposing risk factors. Surgical technique remains a principal suspected risk factor for SWI requiring MFR in this cluster.
Gellert
G A
GA
Orange County Health Care Agency, Santa Ana, CA.
Gordon
S M
SM
Gordon
R S
RS
Strassburg
M
M
Brenner
W I
WI
Fannin
S L
SL
D002140:California / Q000453:epidemiology; D006348:Cardiac Surgical Procedures; D016000:Cluster Analysis; D004196:Disease Outbreaks; D006801:Humans; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology*