title: Risk Factors for Sternal Wound Infection After Open Heart Operations Vary According to Type of Operation.
abstract: BACKGROUND
  This study evaluated whether risk factors for sternal wound infections vary with the type of surgical procedure in cardiac operations.
  
  
  METHODS
  This was a university hospital surveillance study of 3,249 consecutive patients (28% women) from 2006 to 2010 (median age, 69 years [interquartile range, 60 to 76]; median additive European System for Cardiac Operative Risk Evaluation score, 5 [interquartile range, 3 to 8]) after (1) isolated coronary artery bypass grafting (CABG), (2) isolated valve repair or replacement, or (3) combined valve procedures and CABG. All other operations were excluded. Univariate and multivariate binary logistic regression were conducted to identify independent predictors for development of sternal wound infections.
  
  
  RESULTS
  We detected 122 sternal wound infections (3.8%) in 3,249 patients: 74 of 1,857 patients (4.0%) after CABG, 19 of 799 (2.4%) after valve operations, and 29 of 593 (4.9%) after combined procedures. In CABG patients, bilateral internal thoracic artery harvest, procedural duration exceeding 300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female sex (model 1) were independent predictors for sternal wound infection. A second model (model 2), using the European System for Cardiac Operative Risk Evaluation, revealed bilateral internal thoracic artery harvest, diabetes, obesity, and the second and third quartiles of the European System for Cardiac Operative Risk Evaluation were independent predictors. In valve patients, model 1 showed only revision for bleeding as an independent predictor for sternal infection, and model 2 yielded both revision for bleeding and diabetes. For combined valve and CABG operations, both regression models demonstrated revision for bleeding and duration of operation exceeding 300 minutes were independent predictors for sternal infection.
  
  
  CONCLUSIONS
  Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, duration of operation) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female sex) are predictive of sternal wound infection. Preventive interventions may be justified according to the type of operation.
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland; Department for General Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Katharina
authors.initials: K
authors.lastname: Meszaros
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fuehrer
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Sina
authors.initials: S
authors.lastname: Grogg
authors.affiliation: Department of Emergency Medicine, Medical University Vienna, Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland. Electronic address: thierry.carrel@insel.ch.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology*