Lindblom Rickard P F, Lytsy Birgitta, Sandström Camilla, Ligata Nadjira, Larsson Beata, Ransjö Ulrika, Swenne Christine Leo
Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85, Uppsala, Sweden.
Department of Medical Sciences, Unit for Clinical Microbiology and Infectious Medicine, Uppsala University, Uppsala, Sweden.
BMC Cardiovasc Disord. 2015 Nov 17;15:154. doi: 10.1186/s12872-015-0148-4.
Coronary artery by-pass grafting (CABG) remains the optimal strategy in achieving complete revascularization in patients with complex coronary artery disease. However, sternal wound infections (SWI), especially deep SWI are potentially severe complications to the surgery. At the department of cardiothoracic surgery in Uppsala University Hospital a gradual increase in all types of SWI occurred, which peaked in 2009. This prompted an in-depth revision of the whole surgical process. To monitor the frequency of post-operative infections all patients receive a questionnaire that enquires whether any treatment for wound infection has been carried out.
All patients operated with isolated CABG between start of 2006 and end of 2012 were included in the study. 1515 of 1642 patients answered and returned the questionnaire (92.3 %). The study period is divided into the time before the intervention program was implemented (2006-early 2010) and the time after the intervention (early 2010- end 2012). To assess whether potential differences in frequency of SWI were a consequence of change in the characteristics of the patient population rather than an effect of the intervention a retrospective assessment of medical records was performed, where multiple of the most known risk factors for developing SWI were studied.
We noticed a clear decrease in the frequency of SWI after the intervention. This was not a consequence of a healthier population.
Our results from implementing the intervention program are positive in that they reduce the number of SWI. As several changes in the perioperative care were introduced simultaneously we cannot deduce which is the most effective.
冠状动脉旁路移植术（CABG）仍然是实现复杂冠状动脉疾病患者完全血运重建的最佳策略。然而，胸骨伤口感染（SWI），尤其是深部SWI是该手术潜在的严重并发症。在乌普萨拉大学医院心胸外科，各类SWI的发生率逐渐上升，并于2009年达到峰值。这促使对整个手术过程进行深入审查。为监测术后感染的发生率，所有患者均收到一份问卷，询问是否针对伤口感染进行了任何治疗。
本研究纳入了2006年初至2012年末接受单纯CABG手术的所有患者。1642例患者中有1515例回答并返回了问卷（92.3%）。研究期分为干预计划实施前（2006年 - 2010年初）和干预后（2010年初 - 2012年末）。为评估SWI发生率的潜在差异是患者群体特征变化的结果而非干预的影响，对病历进行了回顾性评估，研究了多个最常见的发生SWI的危险因素。
我们注意到干预后SWI的发生率明显下降。这并非是由于患者群体更健康。
我们实施干预计划的结果是积极的，因为它们减少了SWI的数量。由于围手术期护理同时引入了多项改变，我们无法推断出哪一项最有效。
