Analysis of Risk Factors in Poststernotomy Sternal Wound Infection and Mediastinitis after Open-heart Surgery / 대한흉부외과학회지

ABSTRACT

BACKGROUND: With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. MATERIAL AND METHOD: From March 2001 to March 2003 at the department of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. RESULT: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardiopulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant early chest reexploration (p=0.001), sternal rewiring (p<0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p<0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). CONCLUSION: Contamination of patients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.