Sachithanandan et al evaluated adults who had undergone medial sternotomy for cardiac surgery. The outcome studied was deep sternal wound infection that required revision surgery. The authors are from University Hospital Birmingham and University College London.
Patient selection: adult with medial sternotomy for cardiac surgery
Outcome: deep sternal wound infection that required revision surgery
A superficial sternal wound infection was one with mild sternal discharge confined to the skin and subcutaneous tissues and not associated with underlying sternal instability and that settled with simple dressings and antibiotic therapy.
Parameters:
(1) diabetes mellitus (OR 3.63)
(2) smoking history (current, OR 2.35)
(3) age in years (OR 1.03)
(4) ventilation duration in days (OR 1.03, unclear if preoperative or postoperative)
The risk of such infections was increased as the number of risk factors increase.
Major postoperative morbidity:
(1) new renal failure (8%)
(2) tracheostomy (13%)
(3) mechanical ventilation (13%)
(4) new stroke (4%)
4-year survival with deep sternal wound infection requiring revision was 79% (vs 86% for patients without).
