Early onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis
| Autor: | Robbin G. Cohen, Craig J. Baker, Vaughn A. Starnes, Mark L. Barr, Joseph N. Carey, Michael E. Bowdish, Ramsey S. Elsayed |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Sternum Article Cohort Studies Risk Factors Medicine Humans Surgical Wound Infection Cardiac Surgical Procedures Early onset Retrospective Studies business.industry Hazard ratio Odds ratio medicine.disease Wound infection Mediastinitis Confidence interval Surgery Cardiac surgery Cohort Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | J Card Surg |
| Popis: | OBJECTIVES: To compare outcomes after the development of early (≤30 days) versus delayed (>30 days) deep sternal wound infection (DSWI) after cardiac surgery. METHODS: Between 2005 and 2016, 64 patients were treated surgically for DSWI following cardiac surgery. Thirty-three developed early DSWI, while 31 developed late DSWI. Mean follow up was 34.1 ± 32.3 months. RESULTS: Survival for the entire cohort at 1, 3, and 5 years was 93.9, 85.1, and 80.8%, respectively. DSWI diagnosed early and attempted medical management were strongly associated with overall mortality (hazard ratio (HR), 25.0 and 9.9; 95% confidence intervals (CI), 1.18–528 and 1.28–76.5; p-value 0.04 and 0.04, respectively). Survival was 88.1, 77.0, 70.6 and 100, 94.0 and 94.0% at 1,3, and 5 years in the early and late DSWI groups, respectively (Log-rank = 0.074). Those diagnosed early were more likely to have a positive wound culture (odds ratio (OR), 0.06, 95% CI 0.01–0.69, p=0.024) and diagnosed late were more likely to be female (OR 8.75, 95% CI 2.0–38.4, p=0.004) and require an urgent DSWI procedure (OR 9.25, 95% CI 1.86–45.9, p=0.007). Both early diagnosis of DSWI and initial attempted medial management were strongly associated with mortality (hazard ratio 7.48, 95% CI 1.38–40.4, p=0.019 and hazard ratio 7.76, 95% CI 1.67–35.9, p=0.009, respectively). CONCLUSIONS: Early aggressive surgical therapy for deep sternal wound infection after cardiac surgery results in excellent outcomes. Those diagnosed with DSWI early and have failed initial medical management have increased mortality. |
| Databáze: | OpenAIRE |
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