Deep sternal wound infection after coronary artery bypass: How to manage?
Mediastinitis is a devastating sternal wound complication. The aim of this study was to identify the incidence, risk factors, mortality, and different treatment modalities of mediastinitis after isolated coronary artery bypass grafting. From January 2007 to May 2010, 1424 patients who underwent isolated coronary artery bypass grafting were studied retrospectively; 1398 (group 1) had no mediastinitis, and 26 (group 2) developed mediastinitis. The diagnosis and classification of mediastinitis were based on the criteria of the Center for Disease Control and Prevention and the Emory classification, respectively. Multivariate analysis showed only 4 risk factors: diabetes mellitus, obesity, prolonged postoperative intensive care unit stay, and prolonged intubation time. On univariate analysis, female sex, renal failure, and reexploration for bleeding were also significant risk factors. The incidence of mediastinitis (1.83%) and the subsequent mortality rate (7.69%) were comparable to those of previous reports. Early detection and aggressive management of mediastinitis play major roles in decreasing the related mortality and morbidity. The Emory classification with some modification is very helpful in choosing the proper treatment modality.
Department of Cardiothoracic Surgery, Chest Diseases Hospital, Kuwait mohrahman@hotmail.com.
Mohamed Abdelrahman
MA
Badawy
Department of Cardiothoracic Surgery, Chest Diseases Hospital, Kuwait.
Fahad Al
FA
Shammari
Department of Cardiothoracic Surgery, Chest Diseases Hospital, Kuwait.
Tareq
T
Aleinati
Department of Cardiothoracic Surgery, Chest Diseases Hospital, Kuwait.
Moataz Salah
MS
Eldin
Department of Cardiothoracic Surgery, Chest Diseases Hospital, Kuwait.
Riyad
R
Tarazi
Department of Cardiothoracic Surgery, Chest Diseases Hospital, Kuwait.
Jamal
J
Alfadli
D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007730:Kuwait; D016015:Logistic Models; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*
Coronary artery bypass; Mediastinitis; Postoperative complications; Sternum; Surgical wound infection