Vol. 27 No. 1 (2023)
FOLLOW-UP AND INTENSIVE CARE

Preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery: a retrospective study

A.V. Stepin
Ural Institute of Cardiology
Bio

Published 2023-03-30

Keywords

  • Male,
  • Mammary Arteries,
  • Pulmonary Disease, Chronic Obstructive,
  • Surgical Wound Infection,
  • Retrospective Studies,
  • Risk Factors
  • ...More
    Less

How to Cite

Stepin, A. (2023). Preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery: a retrospective study. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 27(1), 30–37. https://doi.org/10.21688/1681-3472-2023-1-30-37

Abstract

Objective: To assess the significance of preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery.
Methods: The retrospective study included data obtained from 1,992 medical records of patients after cardiac surgery. All patients were divided into two groups: with (n=97, 4.9%) or without (n=1,895, 95.1%) infectious complications in the postoperative period. The rate of risk factors in both groups was compared and their impact on the surgical wound infection was assessed. Risk factors were analyzed in the groups of patients with superficial and deep forms of infection.
Results: In the group of patients with surgical wound infection, males are more common than among the patients without it (82.5% vs. 70.95%). Patients with infection were more likely to have an obesity (43.3% vs. 30.3% without surgical wound infection) and chronic obstructive pulmonary disease (24.7% vs. 13.3%, respectively). In the patients with surgical wound infection, two internal mammary arteries were used more often (29.9% vs. 17.3% without surgical wound infection), the crossover variant of using two internal mammary arteries — 55.2% vs. 34.1% without surgical wound infection. According to the results, male gender and chronic obstructive pulmonary disease increase the risk of surgical wound infection twice as much, with obesity increasing this risk by 1.76 times. Using one of the internal mammary arteries may increase the chances of surgical wound infection by 1.7 times, while using two arteries — by 3.27 times. Increasing the number of factors in one patient may increase the chances of complications by 1.31 times.
Conclusion: In cardiac surgery one should assess risk factors of surgical wound infection, plan the surgery (with or without internal mammary arteries), and evaluate the probability of infection complications with personalized approach.

Received 2 February 2022. Revised 20 January 2023. Accepted 16 February 2023.

Funding: The study had no sponsorship.

Conflict of interest: The author declares no conflict of interest.

References

  1. Брико Н.И., Божкова С.А., Брусина Е.Б., Жедаева М.В., Зубарева Н.А., Зуева Л.П., Иванова Е.Б., Казачек Я.В., Квашнина Д.В., Ковалишена О.В., Кузьменко С.А., Павлов В.В., Пасечник И.Н., Попов Д.А., Цигельник А.М., Цой Е.Р., Шмакова М.А., Шубняков И.И., Яковлев С.В. Профилактика инфекций области хирургического вмешательства. Клинические рекомендации. Н. Новгород: Ремедиум Приволжье; 2018. 72 с. Briko N.I., Bozhkova S.A., Brusina E.B., Zhe­dayeva M.V., Zubareva N.A., Zueva L.P., Ivanova E.B., Kazachek Ya.V., Kvashnina D.V., Kovalishena O.V., Kuzmenko S.A., Pavlov V.V., Pasechnik I.N., Popov D.A., Tcigelnik A.M., Tsoi E.R., Shmakova M.A., Shubnyakov I.I., Yakovlev S.V. Prevention of infections of the surgical intervention area. Clinical recommendations. Nizhniy Novgorod: Remedium Privolzh'e Publ.; 2018. 72 p. (In Russ.)
  2. Chung S., Kim W.S., Jeong D.S., Lee J., Lee Y.T. Outcomes of off-pump coronary bypass grafting with the bilateral internal thoracic artery for left ventricular dysfunction. J Korean Med Sci. 2014;29(1):69-75. PMID: 24431908; PMCID: PMC3890479. https://doi.org/10.3346/jkms.2014.29.1.69
  3. Graf K., Ott E., Vonberg R.-P., Kuehn C., Haverich A., Chaberny I.F. Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg. 2010;37(4):893-896. PMID: 19896860. https://doi.org/10.1016/j.ejcts.2009.10.005
  4. Cossin S., Malavaud S., Jarno P., Giard M., L'Hériteau F., Simon L., Bieler L., Molinier L., Marcheix B., Venier A.-G.; ISO-RAISIN Steering Committee. Surgical site infection after valvular or coronary artery bypass surgery: 2008-2011 French SSI national ISO-RAISIN surveillance. J Hosp Infect. 2015;91(3):225-230. PMID: 26321674. https://doi.org/10.1016/j.jhin.2015.07.001
  5. Mehaffey J.H., Hawkins R.B., Byler M., Charles E.J., Fonner C., Kron I., Quader M., Speir A., Rich J., Ailawadi G.; Virginia Cardiac Services Quality Initiative. Cost of individual complications following coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2018;155(3):875-882.e1. PMID: 29248284. https://doi.org/10.1016/j.jtcvs.2017.08.144
  6. Deo S.V., Shah I.K., Dunlay S.M., Erwin P.J., Locker C., Altarab­sheh S.E., Boilson B.A., Park S.J., Joyce L.D. Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients. Ann Thorac Surg. 2013;95(3):862-869. PMID: 23352296. https://doi.org/10.1016/j.athoracsur.2012.11.068
  7. Filsoufi F., Castillo J.G., Rahmanian P.B., Broumand S.R., Silvay G., Carpentier A., Adams D.H. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23(4):488-494. PMID: 19376733. https://doi.org/10.1053/j.jvca.2009.02.007
  8. Jayakumar S., Khoynezhad A., Jahangiri M. Surgical site infections in cardiac surgery. Crit Care Clin. 2020;36(4):581-592. PMID: 32892815. https://doi.org/10.1016/j.ccc.2020.06.006
  9. Pradeep A., Rangasamy J., Varma P.K. Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing. Med Res Rev. 2021;41(2):709-724. PMID: 33174619. https://doi.org/10.1002/med.21758
  10. Shih B.Ch.-H., Chung S., Kim H., Chang H.W., Kim D.J., Lim C., Park K.-H., Kim J.S. Outcomes and patency of complex configurations of composite grafts using bilateral internal thoracic arteries. Korean J Thorac Cardiovasc Surg. 2020;53(2):64-72. PMID: 32309205; PMCID: PMC7155177. https://doi.org/10.5090/kjtcs.2020.53.2.64
  11. Shin Y.Ch., Kim S.H., Kim D.J., Kim D.J., Kim J.S., Lim Ch., Park K.-H. Sternal healing after coronary artery bypass grafting using bilateral internal thoracic arteries: assessment by computed tomography scan. Korean J Thorac Cardiovasc Surg. 2015;48(1):33-39. PMID: 25705595; PMCID: PMC4333848. https://doi.org/10.5090/kjtcs.2015.48.1.33
  12. Tegnell A., Arén C., Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg. 2000;69(4):1104-1109. PMID: 10800801. https://doi.org/10.1016/S0003-4975(99)01563-5
  13. Walsh E.E., Greene L., Kirshner R. Sustained reduction in methicillin-resistant Staphylococcus aureus wound infections after cardiothoracic surgery. Arch Intern Med. 2011;171(1):68-73. PMID: 20837818. https://doi.org/10.1001/archinternmed.2010.326