title: Tracheostomy After Cardiac Surgery With Median Sternotomy and Risk of Deep Sternal Wound Infections: Is It a Matter of Timing?
abstract: OBJECTIVE
  To assess the impact of timing of percutaneous dilatational tracheotomy (PDT) on incidence of deep sternal wound infections (DSWI) after cardiac surgery with median sternotomy.
  
  
  METHODS
  Retrospective study between 2003 and 2013.
  
  
  METHODS
  Single-center university hospital.
  
  
  METHODS
  Eight hundred seventy-nine patients after cardiac surgery with extracorporeal circulation and median sternotomy.
  
  
  METHODS
  PDT using the Ciaglia-technique with direct bronchoscopic guidance.
  
  
  RESULTS
  Mean time from surgery and (re)intubation to PDT was 6.7±9.9 and 3.8±3.3 days, respectively. Incidence of DSWI was 3.9% (34/879). The incidence of DSWI was comparable between patients with PDT performed before postoperative day (POD) 10 and those with PDT after POD 10 (29/755 [3.8%] v 5/124 [4.0%], p = n.s.). However, the authors observed an association of timing of PDT and DSWI: The incidence of DSWI was significantly higher in patients with PDT performed≤POD 1 compared to those with PDT after POD 2 (12/184 [6.52%] v 22/695 [3.16%], p = 0.046). In multivariate analysis, obesity, use of bilateral internal mammary arteries, ICU stay>30 days and PDT<48 hours after surgery (OR 3.519, 95% CI 1.242-9.976, p = 0.0018) were independent predictors of DSWI. In 15/34 patients (44.1%), similarity of microorganisms between sternotomy site and tracheal cultures was observed, indicating a possible cross-contamination.
  
  
  CONCLUSIONS
  PDT within the first 10 postoperative days after cardiac surgery with median sternotomy can be performed safely without an increased risk of DSWI. In contrast, very early PDT within 48 hours after surgery is associated with an increased risk of mediastinitis and should, therefore, be avoided.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany. Electronic address: kevin.pilarczyk@uk-essen.de.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarczyk
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Guenter
authors.initials: G
authors.lastname: Marggraf
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Dudasova
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Ender
authors.initials: E
authors.lastname: Demircioglu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Valerie
authors.initials: V
authors.lastname: Scheer
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Dusse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000639:trends; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology*; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects* / Q000639:trends
keywords: cardiac surgery; deep sternal wound infection; mediastinitis; percutaneous dilatational tracheotomy