Braun Christian, Schroeter Filip, Laux Magdalena Lydia, Kuehnel Ralf-Uwe, Ostovar Roya, Hartrumpf Martin, Necaev Anna-Maria, Sido Viyan, Albes Johannes Maximilian
Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, University Hospital Brandenburg Medical School "Theodor Fontane", Ladeburger Str. 17, 16321 Bernau bei Berlin, Germany.
J Clin Med. 2023 Jun 26;12(13):4271. doi: 10.3390/jcm12134271.
The aim of this study was to investigate the relationship between age and sex in regard to the development of deep sternal wound infections and sternal instability following median sternotomy.
A propensity-score-matching analysis was conducted on 4505 patients who underwent cardiac surgery between 2009 and 2021, all of whom had a BMI of ≥30 kg/m. A total of 1297 matched pairs were determined in the sex group, and 1449 matched pairs we determined in the age group. The distributions of sex, age, diabetes mellitus, delirium, unstable sterna, wire refixation, wire removal, superficial vacuum-assisted wound closure, deep vacuum-assisted wound closure, clamp time, bypass time, logistic EuroSCORE, and BMI were determined.
The 30-day in-hospital mortality was found to be similar in the older and younger groups (8.149% vs. 8.35%, = 0.947), and diabetes mellitus was also equally distributed in both groups. However, postoperative delirium occurred significantly more often in the older group (29.81% vs. 17.46%, < 0.001), and there was a significantly higher incidence in men compared with women (16.96% vs. 26.91%, < 0.001). There were no differences found in the incidence of sternum instability, fractured sternum, superficial vacuum-assisted wound closure, and deep vacuum-assisted wound closure between the age and sex groups.
In conclusion, this study found that sternal instability and deep-wound-healing problems occur with equal frequency in older and younger patients and in men and women following median sternotomy. However, the likelihood of postoperative delirium is significantly higher in older patients and in men. These findings suggest that a higher level of monitoring and care may be required for these high-risk patient groups to reduce the incidence of postoperative delirium and improve outcomes following median sternotomy.
本研究旨在探讨年龄和性别与正中开胸术后深部胸骨伤口感染及胸骨不稳定发生之间的关系。
对2009年至2021年间接受心脏手术且BMI≥30 kg/m的4505例患者进行倾向评分匹配分析。在性别组中确定了1297对匹配对，在年龄组中确定了1449对匹配对。确定了性别、年龄、糖尿病、谵妄、胸骨不稳定、钢丝重新固定、钢丝移除、浅表负压伤口封闭、深部负压伤口封闭、夹闭时间、体外循环时间、逻辑欧洲心脏手术风险评估系统评分及BMI的分布情况。
发现老年组和年轻组的30天院内死亡率相似（8.149%对8.35%，P = 0.947），糖尿病在两组中的分布也相同。然而，老年组术后谵妄的发生率明显更高（29.81%对17.46%，P < 0.001），男性的发生率明显高于女性（16.96%对26.91%，P < 0.001）。年龄组和性别组在胸骨不稳定、胸骨骨折、浅表负压伤口封闭及深部负压伤口封闭的发生率方面未发现差异。
总之，本研究发现，正中开胸术后，老年和年轻患者以及男性和女性发生胸骨不稳定和深部伤口愈合问题的频率相同。然而，老年患者和男性术后发生谵妄的可能性明显更高。这些发现表明，可能需要对这些高危患者群体进行更密切的监测和护理，以降低术后谵妄的发生率并改善正中开胸术后的结局。
