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Postoperative Deep Sternal Wound Infections in Patients Undergoing Coronary Artery Bypass Surgery

Divyesh Rathod , Ketav Lakhia , Divyesh Rathod , Jigar Shah , Pranav Sharma , Vivek Wadhawa , Chirag Doshi , Sanjay Patel

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Journal of Cardiovascular Medicine and Surgery 6(2):p 143-152, April – June 2020. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.6220.9

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Ketav Lakhia, Divyesh Rathod, Jigar Shah, et al. Postoperative Deep Sternal Wound Infections in Patients Undergoing Coronary Artery Bypass Surgery. J Cardiovasc Med Surg 2020;6(2):143–152.
 

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Abstract

Introduction: Open heart surgery is one of the most common surgical procedures performed in developed countries; Coronary Artery Bypass Grafting (CABG), Aortic Valve Replacement (AVR), and Mitral Valve Repair (MVR) being the most common procedures. Our aim of the study is to find out the incidence of DSWI among the patients in of coronary artery bypass grafting during the hospital stay at our institute and risk factors associated with this complication and to formulate a protocol for management of this group of cardiac surgical patients and for minimizing such complications. Methods: The is aretro prospective single center observational study. The study consists of 2772 patients who underwent coronary artery bypass grafting surgery between October 2016 and September 2019 at our institute. Patients were divided in two groups based on the CABG and CABG with DSWI. In Group 1 (2706 patients), while in group 2 (66 patients). All the preoperative baseline, intraoperative and postoperative data were collected. Result: In our study we have found that Preoperative parameters PAD (p<0.0001) and Smoking (p<0.001) were significantly higher in group 2 (CABG + DSWI). Higher weight was associated with increased incidence of DSWI 42.4% of patients having BMI ≥ 30 kg/m2. (p=0.0082). Bypass Grafting with LIMA-RIMA had significantly high development rate for DSWI, LIMA-RIMA CABG performed in Group 1
in 372 (13.7%) patients and in Group 2 in 15 (22.7%) (p=0.0375). In addition, significant difference to develop DSWI is also founds in High drainage Output (≥ 1 lit), Re-exploration, Reintubation in Group 1 (Non DSWI) with 4.5% (122) patients, 3.88% (105) patients and 4.1% (112) patients while in Group 2 have only 27.2% (18), 28.7% (19) and 24.2%(16) respectively (p<0.0001). It had been seen that increase in ICU stay and increase in ventilation stay are again two chief factors to lead DSWI. Conclusion: The present study confirms that preoperative parameters like age > 60 years, uncontrolled DM II, HTN, PAD, Smoking, Obesity (BMI ≥ 30) increase the risk of deep sternal wound
infection. Intraoperative risk factors like LIMA-RIMA grafting, high rate of blood transfusion (PCV > 3 unit) have prompt to increase incidence of DSWI in postoperative period while postoperative parameters like High drainage output (≥ 1 lit), Re-exploration, Reintubation, Longer mechanical ventilation time have also predispose to develop DSWI.


 

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Ketav Lakhia, Divyesh Rathod, Jigar Shah, et al. Postoperative Deep Sternal Wound Infections in Patients Undergoing Coronary Artery Bypass Surgery. J Cardiovasc Med Surg 2020;6(2):143–152.
 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.6220.9

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