title: A National Study of the Impact of Initial Débridement Timing on Outcomes for Patients with Deep Sternal Wound Infection.
abstract: BACKGROUND
  Excisional débridement for patients with deep sternal wound infection is a main component of treatment. This study aims to evaluate the impact of delayed excisional débridement on mortality and associated outcomes.
  
  
  METHODS
  The authors analyzed the MarketScan database from 2009 to 2013 to identify patients with deep sternal wound infection who received surgical intervention. A logistic regression model was created to model mortality. Poisson regression models were used to model number of procedures, number of hospitalizations, and length of stay. A log-linear regression model was used for cost analysis. All analyses were adjusted for patient risk factors.
  
  
  RESULTS
  The final cohort included 1335 patients with 12 percent in-hospital mortality. There was considerable variation in timing of débridement among patients with deep sternal wound infection, with more than 25 percent undergoing initial débridement 4 or more days after diagnosis, and 10 percent undergoing débridement more than 1 week after diagnosis. Patients undergoing delayed débridement had progressively higher risk for greater number of admissions and total hospital days compared with those undergoing early débridement. Patients undergoing débridement on the day of diagnosis of deep sternal wound infection had a predicted 34 total hospital days, compared with 49 total hospital days for patients undergoing débridement more than 7 days after diagnosis.
  
  
  CONCLUSIONS
  Patients treated with early surgical intervention had fewer hospital admissions and fewer hospital days than patients undergoing delayed surgical treatment. Protocols to facilitate early débridement have the potential to improve quality and efficiency of deep sternal wound infection care.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
authors.forename: Lizi
authors.initials: L
authors.lastname: Wu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
authors.forename: Lin
authors.initials: L
authors.lastname: Zhong
authors.forename: Erika D
authors.initials: ED
authors.lastname: Sears
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014946:Wound Infection / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
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