title: Deep sternal wound infection: risk factors and outcomes.
abstract: BACKGROUND
  Deep sternal wound infection (DSWI) is a serious complication 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 review was performed using prospectively gathered data on 12,267 consecutive cardiac surgical patients from 1990 to 1995. Chart review was performed on all patients in whom DSWI developed, and follow-up was obtained 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% confidence 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) bilateral 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 patients, 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). Bilateral internal thoracic artery grafts increased the risk of DSWI in all subgroups of coronary artery bypass graft patients, particularly in diabetics who had a 14.3% incidence of DSWI after bilateral internal thoracic artery grafting. Patients with DSWIs received either sternal debridement with primary closure (n=45) or sternectomy with flap reconstruction (n=46). The 6-month freedom from adverse event rate (ie, readmission, reoperation, or death) was 76% for both groups of patients.
  
  
  CONCLUSIONS
  Male sex and diabetes are predictors of DSWI in all cardiac surgical patients. Bilateral internal thoracic artery grafting may be contraindicated in diabetic patients.
authors.affiliation: Division of Cardiovascular Surgery, The Toronto Hospital, Ontario, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Borger
authors.forename: V
authors.initials: V
authors.lastname: Rao
authors.forename: R D
authors.initials: RD
authors.lastname: Weisel
authors.forename: J
authors.initials: J
authors.lastname: Ivanov
authors.forename: G
authors.initials: G
authors.lastname: Cohen
authors.forename: H E
authors.initials: HE
authors.lastname: Scully
authors.forename: T E
authors.initials: TE
authors.lastname: David
mesh_terms: D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000379:methods; D003646:Debridement; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology* / Q000601:surgery; D015996:Survival Rate; D013895:Thoracic Arteries / Q000637:transplantation; D013908:Thoracotomy / Q000009:adverse effects*; D016896:Treatment Outcome