Association between sternal wound complications and 10-year mortality following coronary artery bypass grafting.

Autor:	Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY. Electronic address: mfg9004@med.cornell.edu., Audisio K; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY., Rahouma M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY., Robinson NB; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY., Soletti GJ; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY., Cancelli G; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY., Masterson Creber RM; Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York City, NY., Gray A; Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom., Lees B; Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom., Gerry S; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom., Benedetto U; Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom., Flather M; Norwich Medical School, University of East Anglia, Norwich, United Kingdom., Taggart DP; Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2023 Aug; Vol. 166 (2), pp. 532-539.e4. Date of Electronic Publication: 2021 Dec 24.
DOI:	10.1016/j.jtcvs.2021.10.067
Abstrakt:	Objective: To evaluate the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial. Methods: Participants in the Arterial Revascularization Trial were stratified according to the occurrence of postoperative SWC. The primary outcome was all-cause mortality at long-term follow-up. The secondary outcome was major adverse cardiovascular events. Results: Three thousand one hundred two patients were included in the analysis; the median follow-up was 10 years. 115 patients (3.7%) had postoperative SWC: 85 (73.9%) deep sternal wound infections and 30 (26.1%) sterile SWC that required sternal reconstruction. Independent predictors of SWC included diabetes (odds ratio [OR], 2.77; 95% CI, 1.79-4.30; P < .001), female sex (OR, 2.73; 95% CI, 1.71-4.38; P < .001), prior stroke (OR, 2.59; 95% CI, 1.12-5.98; P = .03), chronic obstructive pulmonary disease (OR, 2.44; 95% CI, 1.60-3.71; P < .001), and use of bilateral internal thoracic artery (OR, 1.70; 95% CI, 1.12-2.59; P = .01). Postoperative SWC was significantly associated with long-term mortality. The Kaplan-Meier survival estimate was 91.3% at 5 years and 79.4% at 10 years in patients without SWC, and 86.1% and 64.3% in patients with SWC (log rank P < .001). The rate of major adverse cardiovascular events was also higher among patients who had SWC (n = 51 [44.3%] vs 758 [25.4%]; P < .001). Using multivariable analysis, the occurrence of SWC was independently associated with long-term mortality (hazard ratio, 1.81; 95% CI, 1.30-2.54; P < .001). Conclusions: In the Arterial Revascularization Trial, postoperative SWC although uncommon were significantly associated with long-term mortality. (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu