Sachithanandan Anand, Nanjaiah Prakash, Nightingale Peter, Wilson Ian C, Graham Timothy R, Rooney Stephen J, Keogh Bruce E, Pagano Domenico
Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom.
Eur J Cardiothorac Surg. 2008 Apr;33(4):673-8. doi: 10.1016/j.ejcts.2008.01.002. Epub 2008 Feb 19.
To assess the impact of deep sternal wound infection on in-hospital mortality and mid-term survival following adult cardiac surgery.
Prospectively collected data on 4586 consecutive patients who underwent a cardiac surgical procedure via a median sternotomy from 1st January 2001 to 31st December 2005 were analysed. Patients with a deep sternal wound infection (DSWI) were identified in accordance with the Centres for Disease Control and Prevention guidelines. Nineteen variables (patient-related, operative and postoperative) were analysed. Logistic regression analysis was used to calculate a propensity score for each patient. Late survival data were obtained from the UK Central Cardiac Audit Database. Mean follow-up of DSWI patients was 2.28 years.
DSWI requiring revision surgery developed in 1.65% (76/4586) patients. Stepwise multivariable logistic regression analysis identified age, diabetes, a smoking history and ventilation time as independent predictors of a DSWI. DSWI patients were more likely to develop renal failure, require reventilation and a tracheostomy postoperatively. Treatment included vacuum assisted closure therapy in 81.5% (62/76) patients and sternectomy with musculocutaneous flap reconstruction in 35.5% (27/76) patients. In-hospital mortality was 9.2% (7/76) in DSWI patients and 3.7% (167/4510) in non-DSWI patients (OR 1.300 (0.434-3.894) p=0.639). Survival with Cox regression analysis with mean propensity score (co-variate) showed freedom from all-cause mortality in DSWI at 1, 2, 3 and 4 years was 91%, 89%, 84% and 79%, respectively compared with 95%, 93%, 90% and 86%, respectively for patients without DSWI ((p=0.082) HR 1.59 95% CI (0.94-2.68)).
DSWI is not an independent predictor of a higher in-hospital mortality or reduced mid-term survival following cardiac surgery in this population.
评估成人心脏手术后深部胸骨伤口感染对院内死亡率和中期生存率的影响。
对2001年1月1日至2005年12月31日期间通过正中胸骨切开术连续接受心脏手术的4586例患者的前瞻性收集数据进行分析。根据疾病控制与预防中心的指南确定深部胸骨伤口感染（DSWI）患者。分析了19个变量（患者相关、手术和术后变量）。采用逻辑回归分析计算每个患者的倾向评分。晚期生存数据来自英国中央心脏审计数据库。DSWI患者的平均随访时间为2.28年。
1.65%（76/4586）的患者发生了需要翻修手术的DSWI。逐步多变量逻辑回归分析确定年龄、糖尿病、吸烟史和通气时间是DSWI的独立预测因素。DSWI患者术后更易发生肾衰竭，需要再次通气和气管切开。治疗方法包括81.5%（62/76）的患者采用负压封闭引流治疗，35.5%（27/76）的患者采用胸骨切除联合肌皮瓣重建。DSWI患者的院内死亡率为9.2%（7/76），非DSWI患者为3.7%（167/4510）（比值比1.300（0.434 - 3.894），p = 0.639）。通过平均倾向评分（协变量）进行Cox回归分析的生存情况显示，DSWI患者1年、2年、3年和4年的全因死亡率分别为91%、89%、84%和79%，而无DSWI患者分别为95%、93%、90%和86%（（p = 0.082），风险比1.59，95%置信区间（0.94 - 2.68））。
在该人群中，DSWI并非心脏手术后院内死亡率升高或中期生存率降低的独立预测因素。
