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J Thorac Cardiovasc Surg 1996;111:1200-1207
© 1996 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
From The Parisian Mediastinitis Study Group.
Received for publication June 13, 1995; Accepted for publication August 1, 1995. Address for reprints: Jean-Christophe Lucet, MD, MPH, Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale, Hôpital Bichat-Claude Bernard, 46, Rue Henri Huchard, 75018 Paris, France.
Abstract
Several risk factors for deep sternal wound infection after sternotomy remain unclear. To assess and compare risk factors among units, a prospective study included 1830 patients in 10 units during a 4-month period: 960 underwent coronary artery bypass grafting and 870 underwent other procedures. According to the Centers for Disease Control and Prevention definitions, 2.3% of patients (42/1830) acquired a deep sternal wound infection. Independent risk factors for deep sternal wound infection were obesity, coronary artery bypass grafting, reoperation, and postoperative inotropic support. Independent risk factors after coronary artery bypass grafting were obesity, bilateral internal thoracic artery grafting, reoperation, and postoperative inotropic support. In all five of the units usually performing bilateral internal thoracic artery graftings, this procedure was associated with high risk of deep sternal wound infection. Duration of operation was a major risk factor in comparison of the unit with the highest risk of deep sternal wound infection with the other nine units; this suggests that parameters related to the perioperative period were involved. Multicenter surveillance is useful to determine reliable risk factors for deep sternal wound infection, to define a high-risk population before operation, and to assess unit-specific risk factors. (J THORACCARDIOVASCSURG1996;111:1200-7)
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