title: Risk factors for deep sternal wound infection after cardiac surgery: Influence of red blood cell transfusions and chronic infection.
abstract: Deep sternal wound infection (DSWI) following cardiac surgery is a serious complication, but risk factors associated with DSWI have not been fully elucidated.
  
  
  
  We analyzed all DSWI cases at our institution from 2010-2013 in adult cardiac median sternotomy cases, based on Society of Thoracic Surgeons or National Healthcare Safety Network definitions, but with 1-year surveillance postsurgery. Controls were matched 3:1 per case for procedure, age, and year of surgery. Demographic and operative data were pulled from Society of Thoracic Surgeons database and chart review. Potential variables were evaluated using univariate and multivariate conditional logistic regression.
  
  
  
  Out of 1,894 surgeries performed, 39 DSWI cases (2%) and 117 controls were identified. In univariate analyses, patients with red blood cell (RBC) transfusion ≥ 4 units, any platelet transfusion, previous infections, and chronic infections were associated with higher DSWI. RBC transfusion ≥ 4 units (P = .037) and chronic infections (P = .029) remained significant risk factors for DSWI in multivariate analysis. Preoperative anemia alone was not associated with more DSWI, but its interaction with RBC transfusion ≥ 4 units was significant.
  
  
  
  High-volume RBC transfusions and chronic infections were strongly associated with DSWI in our population and represent potentially modifiable areas for improvement.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX; Veterans Affairs North Texas Health Care System, Dallas, TX.
authors.forename: James B
authors.initials: JB
authors.lastname: Cutrell
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX; Parkland Health and Hospital System, Dallas, TX.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Barros
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Mandy
authors.initials: M
authors.lastname: McBroom
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX; Parkland Health and Hospital System, Dallas, TX.
authors.forename: James
authors.initials: J
authors.lastname: Luby
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Abu
authors.initials: A
authors.lastname: Minhajuddin
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: W Steves
authors.initials: WS
authors.lastname: Ring
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: philip.greilich@UTSouthwestern.edu.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Greilich
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: Anemia; Antibiotic prophylaxis; Prevention; Surgical site infection