WOUND INFECTIONS AFTER TOTAL MEDIAN STERNOTOMY –  RISK FACTORS, MICROBIOLOGICAL ANALYSIS, PROPHYLAXIS AND TREATMENT METHODS

Introduction. Median sternotomy represents a standard surgical access in cardiac surgery, despite the growing popularity of minimally invasive access. Posternotomy infections are a serious complication and are directly related to patients' survival in the short and long term. Despite prevention, their expression is still significant - from 0.5% to 6.8%, and associated hospital mortality rates range from 7% to 35%. Aims. Analysis of frequency, risk factors, microbiological agents, prevention options and surgical techniques for deep wound infections after open heart surgery for a 17 - year period. Materials and methods. For the period from October 2002 to June 2019, 146 (1.42% of 10,307 operated) patients were treated at the Cardiac Surgery Clinic at the University Hospital “St. Georgi "diagnosed with deep sternal infection. The study is a retrospective using data from medical records and hospital records. The Center of Disease Control (CDC) criteria were used to define deep sternal infections. Results. The sex ratio is 2.04: 1 – men: women. The average age for both sexes is 65.4 years. The average stay of patients in the intensive care unit was 5 days (from 0 to 46 days), and the average total hospital stay was 15.6 days (from 5 to 55 days). Early postoperative mortality was 13,7%. The most common risk factors were diabetes mellitus, obesity and emergency surgery. Conclusion. Cardiac surgery with total midline sternotomy is associated with a risk of developing mediastinitis. Despite the advances in cardiac surgery and the use of mini-invasive techniques, the rate of development of deep wound infections remains relatively high.

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Emergency resternotomy after open cardiac surgery in the ICU is not a risk factor for deep wound infections

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1037770 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

A Kowalski ◽

F Schoeneich ◽

M Ernst ◽

N Haake ◽

J Cremer

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Wound Infections ◽

Deep Wound

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Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1720999 ◽

2021 ◽

Author(s):

Marcus Rickert ◽

Michael Rauschmann ◽

Nizar Latif-Richter ◽

Mohammad Arabmotlagh ◽

Tamin Rahim ◽

...

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Wound Infection ◽

Spinal Fusion ◽

Negative Pressure Wound Therapy ◽

Wound Infections ◽

Wound Therapy ◽

Postoperative Wound ◽

Deep Wound ◽

The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

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Case report: Diagnosis and emergency surgery on a young patient with extensive aortic dissection without any risk factors

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02216-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masoud Shafiee ◽

Mohsen Shafiee ◽

Noorollah Tahery ◽

Omid Azadbakht ◽

Zeinab Nassari ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Aortic Dissection ◽

Heart Surgery ◽

Heart Diseases ◽

Open Heart Surgery ◽

Rare Condition ◽

Underlying Disease ◽

Case Presentation ◽

History Of

Abstract Background Type A aortic dissection is a very dangerous, fatal, and emergency condition for surgery. Acute aortic dissection is a rare condition, such that many patients will not survive without reconstructive surgery. Case presentation We present a case 24-year-old male who came with symptoms of shortness of breath and cough. The patient underwent ECG, chest radiology, and ultrasound, where the patient was found to have right pleural effusion while his ECG was normal. In the history taken from the patient, he had no underlying disease, no history of heart diseases in his family. For a better diagnosis, ETT and aortic CT angiography was performed on the patient which confirmed the evidence of dissection. Immediately after the diagnosis, necessary arrangements were made for open heart surgery and the patient was prepared for surgery. The patient was admitted in the cardiac surgery ICU for 5 days and his medication was carefully administered. After the conditions were stabilized, the patient was transferred to the post-cardiac surgery ICU ward. The patient was discharged from the hospital one week after the surgery and returned to the office as an OPD one week after his discharge. Conclusion Various risk factors can play a role in creating aortic dissection. Therefore, it is necessary to pay attention to patients’ history for achieving a quick and definitive diagnosis. Therefore, to control the complications of placing the cannula as well as the duration of the surgery, it is very important to reduce the duration of pumping on the patient and to be very careful during the cannula placement.

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Vitamin D for prevention of sternotomy healing complications: REINFORCE-D trial

Trials ◽

10.1186/s13063-020-04920-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Michal Čečrle ◽

Dalibor Černý ◽

Eva Sedláčková ◽

Barbora Míková ◽

Vlasta Dudková ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

Heart Surgery ◽

Soft Tissues ◽

Healing Process ◽

Hospital Readmissions ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Complication Rates ◽

Mechanical Lung Ventilation

Abstract Background Most cardiac surgery patients undergo median sternotomy during open heart surgery. Sternotomy healing is an arduous, very complex, and multifactorial process dependent on many independent factors affecting the sternum and the surrounding soft tissues. Complication rates for median sternotomy range from 0.5 to 5%; however, mortality rates from complications are very variable at 7–80%. Low calcidiol concentration below 80 nmol/L results in calcium absorptive impairment and carries a risk of bone loss, which is considered as a risk factor in the sternotomy healing process. The primary objective of this clinical trial is to compare the incidence of all postoperative sternotomy healing complications in two parallel patient groups administered cholecalciferol or placebo. The secondary objectives are focused on general patient recovery process: sternal bone healing grade at the end of the trial, length of hospitalization, number of days spent in the ICU, number of days spent on mechanical lung ventilation, and number of hospital readmissions for sternotomy complications. Methods This clinical trial is conducted as monocentric, randomized, double-blind, placebo-controlled, with planned enrollment of 600 patients over 4 years, approximately 300 in the placebo arm and 300 in the treatment arm. Males and females from 18 to 95 years of age who fulfill the indication criteria for undergoing cardiac surgery with median sternotomy can be included in this clinical trial, if they meet the eligibility criteria. Discussion REINFORCE-D is the first monocentric trial dividing patients into groups based on serum calcidiol levels, and with dosing based on serum calcidiol levels. This trial may help to open up a wider range of postoperative healing issues. Trial registration EU Clinical Trials Register, EUDRA CT No: 2016-002606-39. Registered on September 8, 2016.

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Risk Factors for Median Sternotomy Dehiscence in Cardiac Surgery

Southern Medical Journal ◽

10.1097/00007611-198911000-00008 ◽

1989 ◽

Vol 82 (11) ◽

pp. 1361-1364 ◽

Cited By ~ 14

Author(s):

W SCOTT McDONALD ◽

MARILYN BRAME ◽

CLAIBORNE SHARP ◽

JANE EGGERSTEDT

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Median Sternotomy

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Sternal Anomalies in Asymptomatic Patients after Median Sternotomy and Potential Influencing Factors

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1607217 ◽

2017 ◽

Vol 66 (06) ◽

pp. 517-522

Author(s):

Simon Sündermann ◽

Hatem Alkadhi ◽

Michele Genoni ◽

Francesco Maisano ◽

Maximilian Emmert ◽

...

Keyword(s):

Risk Factors ◽

Heart Surgery ◽

Plate Fixation ◽

Treatment Options ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Patient Specific ◽

Asymptomatic Patients ◽

Increased Risk ◽

Potential Risk Factors

Background We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA. Methods Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV) procedures via median sternotomy. Sternal bone healing was analyzed for SA and their exact location. Results In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6, p = ns). The distance between wire placement to the proximal edge of the manubrium in normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA. Conclusion At least 30% of patients were at an increased risk for SA after receiving a median sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial in such patients.

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Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting

Cardiovascular Journal ◽

10.3329/cardio.v3i1.6427 ◽

1970 ◽

Vol 3 (1) ◽

pp. 50-54 ◽

Cited By ~ 1

Author(s):

SA Quader ◽

R Sarker ◽

F Ahmed ◽

MK Hasan ◽

AK Beg ◽

...

Keyword(s):

Cardiac Surgery ◽

Hospital Stay ◽

Fast Track ◽

Heart Surgery ◽

Open Heart Surgery ◽

Postoperative Mortality ◽

Control Group ◽

Mortality And Morbidity ◽

Surgical Closure ◽

Fast Tracking

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner. Keywords: Cardiac surgery; Congenital heart disease; Fast track; Hospital discharge. DOI: 10.3329/cardio.v3i1.6427Cardiovasc. j. 2010; 3(1): 50-54

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Gastrointestinal Complications Following Cardiac Surgery.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i1.33 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Alfred Ibrahimi ◽

Saimir Kuçi ◽

Ervin Bejko ◽

Stavri Llazo ◽

Jonela Burimi ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Intestinal Ischemia ◽

Heart Surgery ◽

Open Heart Surgery ◽

Morbidity And Mortality ◽

Gastrointestinal Complication ◽

High Morbidity ◽

Low Cardiac Output Syndrome ◽

Gastrointestinal Complications

Purpose: gastrointestinal complication (GIC) following open heart surgery usually are rare but with high morbidity and mortality. The aim of this study was to see the outcome of these patients after complication, compared with a similar study found in literature. Identifying risk factors preoperatively and postoperatively in our patient’s series, for GIC.Materials and methods: Between January 2012 and December 2017 from 1990 operated cardiac patient 34 of them developed GIC, presenting gastro duodenal bleeding due to active ulcer, liver failure, pancreatitis, cholecystitis, or intestinal ischemia. We performed a retrospective analysis.Results: From all consecutive patient only 1.7 % developed GIC. Mortality rate was 55.8%, especially 100 % mortality in intestinal ischemia patient. Regarding risk factors, those were the same found in other similar study (age, atherosclerosis disease, by pass time, postoperative ARF, Low cardiac output syndrome.)Conclusion: GIC after cardiac surgery are rare but when it happens the mortality is very high not even of late diagnosis. In ages patients, diabetes, long by pass time, long hypoperfusion state. It is recommended to be alert for GIC for detection in early phase, and for reducing as much as possible morbidity and mortality.

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Impact of some intraoperative factors on wound infection in cardiac surgery

Уральский медицинский журнал ◽

10.52420/2071-5943-2021-20-1-36-43 ◽

2021 ◽

Vol 20 (1) ◽

pp. 36-43

Author(s):

A. V. Stepin

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Wound Infection ◽

Heart Surgery ◽

Open Heart Surgery ◽

Wound Infections ◽

Open Heart ◽

Postoperative Wound ◽

Sternal Infection ◽

Mammary Arteries

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.

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