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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2000 October;41(5):709-13

language: English

Risk factors of deep sternal wound infections in coronary artery bypass graft surgery

Fu-Der Wang 1,2, Chi-Hwar Chang 2

From the 1Division of Infectious Disease Department of Medicine, 2Infection Control Committee Veterans General Hospital-Taipei and National Yang-Ming University, Taiwan, ROC


Background. Major infec­tions of ster­nal ­wounds ­after cor­o­nary ­artery ­bypass ­graft sur­gery (­CABG) ­occur infre­quent­ly, but ­when ­they do, ­they con­trib­ute sub­stan­tial mor­bid­ity and mor­tal­ity. We iden­ti­fied sig­nif­i­cant ­risk fac­tors of ­deep ster­nal ­wound infec­tion (­DSWI) fol­low­ing ­CABG and ­hoped to ­plan pro­phy­lac­tic meas­ures for ­high ­risk ­patients in ­order to ­reduce the inci­dence of infec­tion.
Methods. From 1996 to 1997, a ­total of 620 ­patients ­received ­CABG at a med­i­cal cen­ter in Taiwan. The sur­gi­cal ­wound was exam­ined eve­ry day. Wound infec­tions ­were ­defined and clas­si­fied accord­ing to Centers for Diseases Control (CDC) def­i­ni­tions. ­DSWI ­were ­defined as ­those involv­ing the med­i­as­ti­num, ­bone or car­til­age, and infec­tions ­beneath the sub­cu­ta­ne­ous tis­sue. Several ­risk fac­tors ­were ana­lyzed.
Results. We iden­ti­fied 17 (2.7%) ­DSWI. Univariate anal­y­sis indi­cat­ed ­that ASA ­scores, sur­gi­cal ­risk ­index, sur­geon, post­op­er­a­tive low car­diac out­put, re-op­er­a­tion for bleed­ing, re-wir­ing of ster­num, ­length of post­op­er­a­tive ­stay in the inten­sive ­care ­unit, post­op­er­a­tive dura­tion of mechan­i­cal ven­ti­la­tion, oper­a­tion ­time, dura­tion of car­di­o­pul­mo­nary ­bypass. Independent pre­dic­tors by mul­ti­var­i­ate logis­tic regres­sion anal­y­sis ­were re-op­er­a­tion for bleed­ing and oper­a­tion ­time. A ­total of 16 organ­isms ­were iso­lat­ed ­among 14 ­patients. Staphylococ-cus account­ed for ­most iso­lates (93.8%) and the ­most of ­them ­were meth­i­cil­lin-resist­ant (80%).
Conclusions. Re-operation for bleed­ing and oper­a­tion ­time ­were the inde­pen­dent pre­dic­tors.

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