Title : Sternal wound infection following open heart surgery: Incidence, risk factor, pathogen, and mortality
Surgical site infections (SSI) are a significant cause of morbidity and mortality after surgery. Due to its high morbidity and mortality rates after open-heart surgery, sternal wound infection (SWI) is one of the most important consequences to avoid and manage. Staphylococcus species (mainly S. aureus and coagulase-negative staphylococci) are the most frequently reported bacteriological pattern in SWIs cases with positive culture following open-heart surgery. Our aim in this study is to assess the incidence, risk factors, causative organisms, and mortality rates of SWIs in patients who had open-heart surgery over a 9-year period between January, 2011 to December, 2019 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
A retrospective study was done on 634 patients who underwent open heart surgery. Data was collected including patient demographics, BMI, blood groups, history of chronic diseases such as Diabetes, COPD, and Hyperlipidemia, previous cardiac surgery, previous myocardial infarction, duration of the operation, blood transfusion during the operation, length of hospitalization, and bypass time with each type of sternal wound infection.
The incidence of superficial sternal wound infections (SSWI) and deep sternal wound infections (DSWI) was 8.6% and 4.1%, respectively. Coagulase-negative staphylococcus was the most frequently isolated organism from SSWI and DSWI patients. A concomitant Diabetes Mellitus that necessitates blood transfusion was identified as one of the risk variables for SSWI in a multivariate regression study. While concomitant Diabetes, being a woman, and a lengthy hospital stay were independently linked with DSWI. Compared with the SSWI group, the 30- day mortality rate for DSWI patients was 3.8% as opposed to 3.7%. The difference in the survival was not statistically significant. Having an older, longer bypass time, and postoperative problems were independent risk factors for 30-day mortality.
This study found an incidence of SSWI and DSWIs of 8.6% and 4.1% respectively. Multivariate regression analysis showed that risk factors for SSWI were having a comorbid diabetes mellitus, requiring blood transfusion. While DSWI independently was associated with the female gender, comorbid diabetes, and long hospitalization period. The 30-day mortality was 3.8% for DSWI patients compared with 3.7% for SSWI group. Future studies in various healthcare settings are required in order to generalize the results because this was a single center study.
Audience take away:
- The importance of surgical site infections and the associated morbidity and mortality rates.
- Incidence, risk factors, and mortality rate of surgical wound infections in patients who had open-heart surgery.
- It will help them recognize what are the microorganisms following open-heart surgery.
- The difference between the risk factors and the incidence of superficial sternal wound infections and deep sternal wound infections after open-heart surgery.