Predictors of Deep Thoracic Wound Infection in Cardiac Surgery

Abstract

  Deep surgical site infection (DSSI) is a rare but serious surgical complication. We assessed the incidence and risk factors for DSSI after cardiovascular surgery. Data were analyzed on 1,212 patients who underwent consecutive cardiovascular surgeries between 2003 and 2009. DSSI was defined as a deep sternal wound infection or mediastinitis. The incidence of DSSI was 3.1% (n=37); one of these patients died during hospitalization. Univariate predictors of DSSI were being male, and having diabetes mellitus, creatinine >1.9 mg/dl, peripheral vascular disease, surgery duration >5 h, and re-exploration for bleeding. Use of bilateral internal thoracic artery grafts increased the risk of DSSI in patients undergoing coronary artery bypass grafting. Multivariate regression analysis demonstrated that significant independent predictors for DSSI were impaired renal function (odds ratio [OR], 2.1; p=0.049), duration of surgery (OR, 2.6; p=0.036), and peripheral vascular disease (OR, 2.6; p=0.021). The mean length hospital stay was significantly longer for patients with DSSI compared to patients without DSSI (80 vs. 22 days). These data suggested that a shorter procedure is important to prevent DSSI in patients with advanced systemic atherosclerosis.