Portal de Periódicos da CAPES

Major Sternal Wound Infection after Open-Heart Surgery: A Multivariate Analysis of Risk Factors in 2,579 Consecutive Operative Procedures

1987; Elsevier BV; Volume: 44; Issue: 2 Linguagem: Inglês

10.1016/s0003-4975(10)62035-8

1552-6259

Gianmaria Ottino, Ruggero De Paulis, Stefano Pansini, Giuseppe Rocca, Maria Vittoria Tallone, Chiara Comoglio, Paolo Costa, F Orzan, M Morea,

Cardiac, Anesthesia and Surgical Outcomes

the Cardiac Surgery Department of the University of Torino Medical School, major sternal wound infections developed in 48 (1.86%) of 2,579 consecutive patients.These patients underwent open-heart procedures through a midline sternotomy and survived long enough for infection to appear.Possible risk factors were evaluated by means of a multivariate analysis.For the group of patients, we considered age, sex, hospital environment (different locations of our surgical facilities over the years), interval between hospital admission and operation, antibiotic prophylaxis, 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 treatment in the intensive care unit.Univariate analysis indicated that age, sex, type and mode of surgical procedure, antibiotic prophylaxis, and duration of mechanical ventilation were not significantly associated with wound infection.For all other predisposing factors, a p value of less than .05was demonstrated.These variables were entered in a multiple stepwise logistic regression.Six emerged as significant: hospital environment ( p = .0001),interval between admission and surgery ( p = .041),reoperation ( p < .0001),blood transfusions ( p = .031),early chest reexploration ( p < .0001),and sternal rewiring ( p < .0001).Contamination of patients may occur before, during, and after operation, and any kind of reintervention may predispose to wound infection.Major infections of sternal wounds after open-heart operations are rare but may seriously affect the postoperative course.Their occurrence ranges between 0.4 and 5%