Risk factors for sternal wound infection in men versus women

2001 ◽  
Vol 10 (2) ◽  
pp. 112-116 ◽  
Author(s):  
LC Hussey ◽  
L Hynan ◽  
B Leeper
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Wound Infection ◽  
Internal Mammary Artery ◽  
Univariate Analysis ◽  
Complication Rates ◽  
Sternal Wound Infection ◽  
Infection Group ◽  
Men And Women ◽  
Internal Mammary

BACKGROUND: Differences between men and women in complication rates after cardiac surgery have been reported. The rate of one of the most severe postoperative complications, sternal wound infection, has not been compared between the sexes. OBJECTIVE: To compare the frequencies of 21 risk factors for sternal wound infection between men and women. METHODS: Records of 306 patients who had cardiac surgery between 1989 and 1999 at 3 different hospitals in the southwestern and southeastern United States were reviewed for 21 risk factors. Of the 306 patients, 115 (25 women and 90 men) had experienced a sternal wound infection and 191 randomly selected patients (52 women and 139 men) had not. RESULTS: Three risk factors occurred at significantly different rates in men and women. Smoking and use of a single internal mammary artery for grafting were more common in men than women. Women were older than men at the time of cardiac surgery. Logistic regression analyses showed that the 3 dichotomous risk factors (use of single internal mammary artery for grafting, smoking, age > 70 years) that univariate analysis indicated were significantly related to sex could also be used to predict infection group. CONCLUSIONS: This study contributes to the awareness of the possible differences between men and women in the risk of sternal wound infection developing after cardiac surgery. Although 3 risk factors occurred at significantly different rates in men and women, further research is needed to determine the effects that these differences in risk factors may have on the occurrence of sternal wound infection in men and women.

scholarly journals Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting

1994 ◽  
Vol 107 (1) ◽  
pp. 196-202 ◽  
Author(s):  
Guo-Wei He ◽  
William H. Ryan ◽  
Tea E. Acuff ◽  
Richard T. Bowman ◽  
Mark B. Douthit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Infection ◽  
Internal Mammary Artery ◽  
Operative Mortality ◽  
Sternal Wound Infection ◽  
Internal Mammary

Mediastinitis Post Cardiac Surgery and the Role of the Internal Mammary Artery: An Updated Risk Factors Analysis

2010 ◽  
Vol 126 ◽  
pp. 84-85
Author(s):  
Hani Sinno ◽  
Gordan Samoukovic ◽  
Rakesh K. Chaturvedi ◽  
Stephane L.W. Sang ◽  
Ahsan Alam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Internal Mammary Artery ◽  
Factors Analysis ◽  
Internal Mammary ◽  
Post Cardiac Surgery

Risk Factors and Management Approach for Deep Sternal Wound Infection After Cardiac Surgery at a Tertiary Medical Centre

2011 ◽  
Vol 20 (11) ◽  
pp. 712-717 ◽  
Author(s):  
Peter Floros ◽  
Raja Sawhney ◽  
Marosh Vrtik ◽  
Anton Hinton-Bayre ◽  
Paul Weimers ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Wound Infection ◽  
Medical Centre ◽  
Management Approach ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection

Management of the recurrent sternal wound infection

1995 ◽  
Vol 3 (3) ◽  
pp. 1-10
Author(s):  
Geoffrey G Hallock
Keyword(s):  
Wound Infection ◽  
Internal Mammary Artery ◽  
Selection Process ◽  
Artery Bypass ◽  
Muscle Flap ◽  
Bypass Grafting ◽  
Sternal Wound Infection ◽  
Flap Transfer ◽  
Accepted Standard ◽  
Internal Mammary

After adequate sternal debridement or resection for the treatment of a sternal wound infection, muscle flap obliteration of the resulting void has become an accepted standard. Unfortunately, recurrence is not an inconsequential risk as evidenced in six (20.7%) of our patients over the last 10 years. Two of these patients required a second muscle flap transfer before obtaining a healed wound. Since the available regional options for appropriate vascularized flaps is limited, especially with the increased frequency in use of the internal mammary artery for coronary artery bypass grafting, great care must be observed in the selection process not just for closure of the initial wound, but in anticipation of untoward sequela. A schema prioritizing alternatives has been established, so as to maximize the benefit of our workhorse flaps, the pectoralis major or rectus abdominis muscles.

scholarly journals Prevention, Classification and Management Review of Deep Sternal Wound Infection

2020 ◽  
Vol 23 (5) ◽  
pp. E652-E657
Author(s):  
Khaled Alebrahim ◽  
Ebrahim Al-Ebrahim
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Wound Infection ◽  
Management Strategy ◽  
Wound Complications ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Different Types ◽  
Post Cardiac Surgery

Sternal wound complications are significant problems in cardiac surgery and cause challenges to surgeons as they are associated with high mortality, morbidity, and a tremendous load on the hospital budget. Risk factors and preventive measures against sternal wound infection need to be in focus. Classification of different types of sternotomy complications post cardiac surgery is important for specific categorization and management. Reviewing the literature, a variety of classifications was introduced to help understand the pathophysiology of these wounds and how best to manage them. Initial classifications were based on the postoperative period of the infectious process and risk factors. Recently, the anatomical description of sternal wound, including the depth and location, was shown to be more practical. There is a lack of evidence-based surgical consensus for the appropriate management strategy, including type of closure, choice of sternal coverage post sternectomy, whether primary, delayed and when to use reconstructive flaps.

scholarly journals Skeletonized versus pedicled left internal mammary artery harvesting and risk of sternal wound infection after coronary artery bypass surgery

2020 ◽  
Author(s):  
Ahmed Mohamed Farghaly ◽  
Mohamed Alaa Nady ◽  
Ahmed Elminshawy
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Wound Infection ◽  
Lower Incidence ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Sternal Wound Infection ◽  
Internal Mammary

Background: The left internal mammary artery (LIMA) is the gold standard conduit for coronary artery bypass grafting (CABG). There are two harvesting methods, either pedicled or skeletonized. The choice of any technique must consider its complication profile, especially sternal wound infections (SWI). This study aims to evaluate and compare the occurrence of SWI after pedicled and skeletonized LIMA harvesting techniques for CABG. Methods: This prospective observational study included 300 patients who had CABG between 2016 and 2019. We included patients who had pedicled LIMA (n=200) in group 1 and who had skeletonized LIMA (n=100) in group 2. All patients completed a follow-up period of 3 months after CABG. The evaluation during follow-up included: sternal instability, signs of wound infection, temperature, the microbiological study of wound discharge, and chest computed tomography scan. Results: There was no significant differences in age (p = 0.20), male to female ratio (p = 0.43), body mass index (p = 0.12), NYHA I/II (p = 0.50), diabetes mellitus (p = 0.28), ejection  fraction (p= 0.14), and EuroSCORE II (p= 0.09) between groups. No significant difference in cardiopulmonary bypass time (p = 0.24), and cross-clamp time (p= 0.19) between groups. There was a significant increase in the total operating time in skeletonized LIMA group (212.77±75.25 min vs. 190.78±55 minutes, p= 0.004). Skeletonized LIMA was significantly associated lower incidence of SWI than that with pedicled LIMA (4% vs 15.5%, p= 0.003), and non-significantly lower incidence of deep SWI (1% vs 4.5%, p= 0.11). The risk factors for SWI in patients who had pedicled IMA were obesity (OR: 13.06, 95%CI: 3.98-42.89), diabetes mellitus (OR: 10.51, 95%CI: 2.35-46.84), and excessive diathermy (OR: 12.62, 95%CI: 3.93-40.54). Conclusion: Obesity, diabetes, and the use of excessive diathermy for hemostasis may increase the risk of sternal wound infection with pedicled LIMA harvest compared to skeletonized LIMA in patients undergoing CABG.

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