Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables

• Published in: European journal of cardio-thoracic surgery Vol. 19; no. 4; pp. 471 - 476
• Main Authors: Noyez, Luc, van Druten, Johannes A.M., Mulder, Jan, Schroën, Alma M.A., Skotnicki, Stefan H., Brouwer, René M.H.J.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.04.2001; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Comorbidity; Coronary Artery Bypass; Coronary Disease - epidemiology; Coronary Disease - surgery; Female; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Postoperative morbidity; Risk Assessment; Risk Factors; Sternum; Sternum - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgical Wound Infection - epidemiology; Wound complication; Myocardial revascularization; Postoperative morbidity; Sternum; Wound complication; Human; Prognosis; Exploration; Risk analysis; Trauma; Wound; Morbidity; Aortocoronary; Bypass; Surgery; Risk factor; Complication; Graft
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(01)00610-8

Objective: Select pre-, peri-, and post-operative variables, predictive for sternal wound complications (SWC), in a clinical setting. Methods: We analyzed pre-, peri-, and post-operative data of 3815 patients who underwent a primary isolated bypass grafting. 100 patients (2.6%) had post-operative SWC. Unifactor and multifactor risk analysis, were used for statistical analysis. Results: Unifactor analysis identified age (P = 0.05), obesity (P = 0.001), lung disease (P = 0.001), extracorporeal circulation ≫100 min (P = 0.002), graft choice (P = 0.01), post-operative low cardiac output, reoperation, nephrological, pulmonary problems (P < 0.001) as risk factors. Multifactor analysis, identified obesity (P = 0.05), reoperation (P = 0.001), nephrological (P = 0.0001), pulmonary problems (P = 0.01) and No-IMA-use (P = 0.05) as independent predictors. Age ≪50 years (P = 0.0001) decreased the risk for SWC. There is, however, an interaction of the graft-use and the pre-operative and post-operative predictors, that can mask the precise effect of the graft-use. Conclusion: Reoperation, nephrological and pulmonary problems are strong predictors, obesity and age independent preoperative risk factors for sternal wound complications.