Risk factors for deep sternal wound infection after cardiac surgery: Influence of red blood cell transfusions and chronic infection

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Deep sternal wound infection (DSWI) following cardiac surgery is a serious complication, but risk factors associated with DSWI have not been fully elucidated. Methods: We analyzed all DSWI cases at our institution from 2010-2013 in adult cardiac median sternotomy cases, based on Society of Thoracic Surgeons or National Healthcare Safety Network definitions, but with 1-year surveillance postsurgery. Controls were matched 3:1 per case for procedure, age, and year of surgery. Demographic and operative data were pulled from Society of Thoracic Surgeons database and chart review. Potential variables were evaluated using univariate and multivariate conditional logistic regression. Results: Out of 1,894 surgeries performed, 39 DSWI cases (2%) and 117 controls were identified. In univariate analyses, patients with red blood cell (RBC) transfusion ≥ 4 units, any platelet transfusion, previous infections, and chronic infections were associated with higher DSWI. RBC transfusion ≥ 4 units (P = .037) and chronic infections (P = .029) remained significant risk factors for DSWI in multivariate analysis. Preoperative anemia alone was not associated with more DSWI, but its interaction with RBC transfusion ≥ 4 units was significant. Conclusions: High-volume RBC transfusions and chronic infections were strongly associated with DSWI in our population and represent potentially modifiable areas for improvement.

Original languageEnglish (US)
JournalAmerican Journal of Infection Control
DOIs
StateAccepted/In press - 2016

Fingerprint

Erythrocyte Transfusion
Wound Infection
Thoracic Surgery
Infection
Platelet Transfusion
Sternotomy
Anemia
Multivariate Analysis
Logistic Models
Demography
Databases
Delivery of Health Care
Safety

Keywords

  • Anemia
  • Antibiotic prophylaxis
  • Prevention
  • Surgical site infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Health Policy

Cite this

@article{bb665b59b23e44898572039b7b42ef38,
title = "Risk factors for deep sternal wound infection after cardiac surgery: Influence of red blood cell transfusions and chronic infection",
abstract = "Background: Deep sternal wound infection (DSWI) following cardiac surgery is a serious complication, but risk factors associated with DSWI have not been fully elucidated. Methods: We analyzed all DSWI cases at our institution from 2010-2013 in adult cardiac median sternotomy cases, based on Society of Thoracic Surgeons or National Healthcare Safety Network definitions, but with 1-year surveillance postsurgery. Controls were matched 3:1 per case for procedure, age, and year of surgery. Demographic and operative data were pulled from Society of Thoracic Surgeons database and chart review. Potential variables were evaluated using univariate and multivariate conditional logistic regression. Results: Out of 1,894 surgeries performed, 39 DSWI cases (2{\%}) and 117 controls were identified. In univariate analyses, patients with red blood cell (RBC) transfusion ≥ 4 units, any platelet transfusion, previous infections, and chronic infections were associated with higher DSWI. RBC transfusion ≥ 4 units (P = .037) and chronic infections (P = .029) remained significant risk factors for DSWI in multivariate analysis. Preoperative anemia alone was not associated with more DSWI, but its interaction with RBC transfusion ≥ 4 units was significant. Conclusions: High-volume RBC transfusions and chronic infections were strongly associated with DSWI in our population and represent potentially modifiable areas for improvement.",
keywords = "Anemia, Antibiotic prophylaxis, Prevention, Surgical site infection",
author = "Cutrell, {James B.} and Nicolas Barros and Mandy McBroom and James Luby and Abu Minhajuddin and Ring, {W. Steves} and Greilich, {Philip E.}",
year = "2016",
doi = "10.1016/j.ajic.2016.03.027",
language = "English (US)",
journal = "American Journal of Infection Control",
issn = "0196-6553",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Risk factors for deep sternal wound infection after cardiac surgery

T2 - Influence of red blood cell transfusions and chronic infection

AU - Cutrell, James B.

AU - Barros, Nicolas

AU - McBroom, Mandy

AU - Luby, James

AU - Minhajuddin, Abu

AU - Ring, W. Steves

AU - Greilich, Philip E.

PY - 2016

Y1 - 2016

N2 - Background: Deep sternal wound infection (DSWI) following cardiac surgery is a serious complication, but risk factors associated with DSWI have not been fully elucidated. Methods: We analyzed all DSWI cases at our institution from 2010-2013 in adult cardiac median sternotomy cases, based on Society of Thoracic Surgeons or National Healthcare Safety Network definitions, but with 1-year surveillance postsurgery. Controls were matched 3:1 per case for procedure, age, and year of surgery. Demographic and operative data were pulled from Society of Thoracic Surgeons database and chart review. Potential variables were evaluated using univariate and multivariate conditional logistic regression. Results: Out of 1,894 surgeries performed, 39 DSWI cases (2%) and 117 controls were identified. In univariate analyses, patients with red blood cell (RBC) transfusion ≥ 4 units, any platelet transfusion, previous infections, and chronic infections were associated with higher DSWI. RBC transfusion ≥ 4 units (P = .037) and chronic infections (P = .029) remained significant risk factors for DSWI in multivariate analysis. Preoperative anemia alone was not associated with more DSWI, but its interaction with RBC transfusion ≥ 4 units was significant. Conclusions: High-volume RBC transfusions and chronic infections were strongly associated with DSWI in our population and represent potentially modifiable areas for improvement.

AB - Background: Deep sternal wound infection (DSWI) following cardiac surgery is a serious complication, but risk factors associated with DSWI have not been fully elucidated. Methods: We analyzed all DSWI cases at our institution from 2010-2013 in adult cardiac median sternotomy cases, based on Society of Thoracic Surgeons or National Healthcare Safety Network definitions, but with 1-year surveillance postsurgery. Controls were matched 3:1 per case for procedure, age, and year of surgery. Demographic and operative data were pulled from Society of Thoracic Surgeons database and chart review. Potential variables were evaluated using univariate and multivariate conditional logistic regression. Results: Out of 1,894 surgeries performed, 39 DSWI cases (2%) and 117 controls were identified. In univariate analyses, patients with red blood cell (RBC) transfusion ≥ 4 units, any platelet transfusion, previous infections, and chronic infections were associated with higher DSWI. RBC transfusion ≥ 4 units (P = .037) and chronic infections (P = .029) remained significant risk factors for DSWI in multivariate analysis. Preoperative anemia alone was not associated with more DSWI, but its interaction with RBC transfusion ≥ 4 units was significant. Conclusions: High-volume RBC transfusions and chronic infections were strongly associated with DSWI in our population and represent potentially modifiable areas for improvement.

KW - Anemia

KW - Antibiotic prophylaxis

KW - Prevention

KW - Surgical site infection

UR - http://www.scopus.com/inward/record.url?scp=84970025029&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84970025029&partnerID=8YFLogxK

U2 - 10.1016/j.ajic.2016.03.027

DO - 10.1016/j.ajic.2016.03.027

M3 - Article

C2 - 27179393

AN - SCOPUS:84970025029

JO - American Journal of Infection Control

JF - American Journal of Infection Control

SN - 0196-6553

ER -