title: Assessment of the Association of Bilateral Internal Thoracic Artery Skeletonization and Sternal Wound Infection After Coronary Artery Bypass Grafting.
abstract: BACKGROUND
  Skeletonization is a technique of bilateral internal thoracic artery (BITA) harvest that preserves sternal blood flow. We sought to identify the relationship of skeletonization and sternal wound infection in a population undergoing BITA harvest.
  
  
  METHODS
  Demographics and outcomes were recorded from patients undergoing coronary artery bypass graft surgery with BITA using either skeletonized (n = 531) or nonskeletonized (n = 970) techniques. The primary outcome was total infection. Propensity scores analysis as well as univariable and multivariable analysis was performed to determine the effect of skeletonization in the total cohort and in each sex.
  
  
  RESULTS
  Although patients undergoing skeletonized BITA had a lower body mass index, they were significantly older, with a higher proportion of women, diabetes mellitus, urgent or emergent surgery, renal failure, vascular and lung disease, and lower preoperative hemoglobin. There was a significant effect of skeletonization in decreasing total infection incidence (odds ratio [OR] 0.606, 95% confidence interval [CI]: 0.383 to 0.959, p = 0.032). The effect of skeletonization on total infection in men was more prominent (OR 0.466, 95% CI: 0.290 to 0.870), whereas there was no effect in women (OR 0.887, 95% CI: 0.441 to 1.786). Multivariable analysis confirmed that skeletonization was protective (OR 0.606, 95% CI: 0.383 to 0.957, p = 0.032). Other factors associated included being female (OR 3.327, 95% CI: 2.080 to 5.322, p < 0.001), insulin-dependent diabetes mellitus (OR 2.638, 95% CI: 1.506 to 4.624, p = 0.001), peripheral vascular disease (OR 2.101, 95% CI: 1.247 to 3.539, p = 0.005), increased body mass index (OR 1.100, 95% CI: 1.054 to 1.149, p < 0.001), and decreased preoperative hemoglobin (OR 0.984, 95% CI: 0.972 to 0.997, p = 0.013).
  
  
  CONCLUSIONS
  Skeletonization is associated with a significant protective effect with regard to sternal infection after coronary artery bypass graft surgery with BITA. Being female is a major risk factor for infection, and the risk is not modified significantly with a strategy of skeletonization in women.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: frubens@ottawaheart.ca.
authors.forename: Fraser D
authors.initials: FD
authors.lastname: Rubens
authors.affiliation: Division of Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Division of Cardiac Anesthesia, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Bourke
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology*