Filsoufi Farzan, Castillo Javier G, Rahmanian Parwis B, Broumand Stafford R, Silvay George, Carpentier Alain, Adams David H
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029-1028, USA.
J Cardiothorac Vasc Anesth. 2009 Aug;23(4):488-94. doi: 10.1053/j.jvca.2009.02.007. Epub 2009 Apr 19.
The aim of this study was to investigate the incidence and predictors of deep sternal wound infection (DSWI) in a contemporary cohort of patients undergoing cardiac surgery. The early and late outcomes of patients with this complication also were analyzed.
A retrospective study of consecutive patients undergoing cardiac surgery using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively.
A university hospital (single institution).
Five thousand seven hundred ninety-eight patients who underwent cardiac surgery between January 1998 and December 2005 including isolated coronary artery bypass graft (CABG) (n = 2,749, 47%), single- or multiple-valve surgery (n = 1,280, 22%), combined valve and CABG procedures (n = 934, 16%), and surgery involving the ascending aorta or the aortic arch (n = 835, 15%).
None.
The overall incidence of DSWI was 1.8% (n = 106). The highest rate of DSWI occurred after combined valve/CABG surgery (2.4%, n = 22) and aortic procedures (2.4%, n = 19). Multivariate analysis revealed 11 predictors of DSWI: obesity (odds ratio [OR] = 2.2), previous myocardial infarction (OR = 2.1), diabetes (OR = 1.7), chronic obstructive pulmonary disease (OR = 2.3), preoperative length of stay >3 days (OR = 1.9), aortic calcification (OR = 2.7), aortic surgery (OR = 2.4), combined valve/CABG procedures (OR = 1.9), cardiopulmonary bypass time (OR = 1.8), re-exploration for bleeding (OR = 6.3), and respiratory failure (OR = 3.2). The mortality rate was 14.2% (n = 15) versus 3.6% (n = 205) in the control group (p < 0.001). One- and 5-year survival after DSWI were significantly decreased (72.4% +/- 4.4% and 55.8% +/- 5.6% v 93.8% +/- 0.3% and 82.0% +/- 0.6%, p < 0.001).
DSWI remains a rare but devastating complication and is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival.
本研究旨在调查当代心脏手术患者中深部胸骨伤口感染（DSWI）的发生率及预测因素。同时分析发生该并发症患者的早期和晚期结局。
一项基于纽约州卫生部登记处的计算机数据库，对连续接受心脏手术患者的回顾性研究。数据收集为前瞻性进行。
一所大学医院（单一机构）。
1998年1月至2005年12月期间接受心脏手术的5798例患者，包括单纯冠状动脉旁路移植术（CABG）（n = 2749，47%）、单瓣膜或多瓣膜手术（n = 1280，22%）、瓣膜与CABG联合手术（n = 934，16%）以及涉及升主动脉或主动脉弓的手术（n = 835，15%）。
无。
DSWI的总体发生率为1.8%（n = 106）。DSWI发生率最高的是瓣膜/CABG联合手术后（2.4%，n = 22）以及主动脉手术后（2.4%，n = 19）。多因素分析显示DSWI的11个预测因素：肥胖（比值比[OR]=2.2）、既往心肌梗死（OR = 2.1）、糖尿病（OR = 1.7）、慢性阻塞性肺疾病（OR = 2.3）、术前住院时间>3天（OR = 1.9）、主动脉钙化（OR = 2.7）、主动脉手术（OR = 2.4）、瓣膜/CABG联合手术（OR = 1.9）、体外循环时间（OR = 1.8）、再次开胸止血（OR = 6.3）以及呼吸衰竭（OR = 3.2）。死亡率为14.2%（n = 15），而对照组为3.6%（n = 205）（p<0.001）。DSWI后1年和5年生存率显著降低（分别为72.4%±4.4%和55.8%±5.6%，对比93.8%±0.3%和82.0%±0.6%，p<0.001）。
DSWI仍然是一种罕见但具有破坏性的并发症，与显著的合并症、医院死亡率增加以及长期生存率降低相关。
