title: Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.
abstract: BACKGROUND
  Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery.
  
  
  METHODS
  Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated.
  
  
  RESULTS
  In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE.
  
  
  CONCLUSIONS
  Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.
authors.affiliation: School of Medicine, Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey.
authors.forename: Gunduz
authors.initials: G
authors.lastname: Yumun
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Erdolu
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
authors.forename: Faruk
authors.initials: F
authors.lastname: Toktas
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Eris
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
authors.forename: Derih
authors.initials: D
authors.lastname: Ay
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Turk
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
authors.forename: Ahmet Kagan
authors.initials: AK
authors.lastname: As
mesh_terms: D015984:Causality; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000401:mortality*; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology