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Michael A. Borger
Vivek Rao
Richard D. Weisel
Gideon Cohen
Hugh E. Scully
Tirone E. David
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Ann Thorac Surg 1998;65:1050-1056
© 1998 The Society of Thoracic Surgeons

Deep Sternal Wound Infection: Risk Factors and Outcomes

Michael A. Borger, MDaa, Vivek Rao, MDaa, Richard D. Weisel, MDaa, Joan Ivanov, MScaa, Gideon Cohen, MDaa, Hugh E. Scully, MDaa, Tirone E. David, MDaa

a Division of Cardiovascular Surgery, The Toronto Hospital, and Centre for Cardiovascular Research and the Collaborative Program in Cardiovascular Sciences, University of Toronto, Toronto, Ontario, Canada

Accepted for publication November 7, 1997.

Address reprint requests to Dr Weisel, Division of Cardiovascular Surgery, The Toronto Hospital, EN 14-215, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4

Background. Deep sternal wound infection (DSWI) is a serious complication of cardiac operations performed by median sternotomy. We attempted to define the predictors of DSWI and to describe the outcomes of two treatment strategies used at our institution.

Methods. Retrospective review was performed using prospectively gathered data on 12,267 consecutive cardiac surgical patients from 1990 to 1995. Chart review was performed on all patients in whom DSWI developed, and follow-up was obtained on 100% of these patients.

Results. Deep sternal wound infections developed in 92 patients (incidence 0.75%). Multivariable predictors for development of DSWI in all patients were (odds ratios and 95% confidence intervals in parentheses) (1) diabetes mellitus (2.6; 1.7 to 4.0) and (2) male sex (2.2; 1.3 to 3.9). In patients receiving coronary artery bypass grafting alone, independent predictors were (1) bilateral internal thoracic artery grafts (3.2; 1.1 to 8.9), (2) diabetes (2.7; 1.6 to 4.3), and (3) male sex (1.8; 0.9 to 3.7). For all other patients, predictors were (1) age more than 74 years (3.3; 1.1 to 10.1), (2) male sex (3.0; 1.1 to 8.1), and (3) diabetes (2.3; 0.9 to 5.8). Bilateral internal thoracic artery grafts increased the risk of DSWI in all subgroups of coronary artery bypass graft patients, particularly in diabetics who had a 14.3% incidence of DSWI after bilateral internal thoracic artery grafting. Patients with DSWIs received either sternal debridement with primary closure (n = 45) or sternectomy with flap reconstruction (n = 46). The 6-month freedom from adverse event rate (ie, readmission, reoperation, or death) was 76% for both groups of patients.

Conclusions. Male sex and diabetes are predictors of DSWI in all cardiac surgical patients. Bilateral internal thoracic artery grafting may be contraindicated in diabetic patients.






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