Ottino et al identified risk factors associated with major sternal wound infections occurring after open heart surgery. These can help identify patients at risk for infection who may be candidates for preventive care and close monitoring. The authors are from the University of Torino and S. Giovanni Battista Hospital in Torino, Italy.
Patient selection: open heart surgery through a midline sternotomy
Patients received prophylactic antibiotics.
Risk factors based on multiple stepwise logistic regression analysis:
(1) hospital environment (suboptimal location difficult to clean effectively)
(2) number of days between admission to the hospital and surgery (noninfected patients had stays <= 12 days prior to surgery while infected patients had stays > 12 days)
(3) reoperation (history of a previous surgery through either a thoracotomy or midline sternotomy
(4) volume of blood transfusion (noninfected patients used approximately 2 units of packed RBCs, while infected patients used > 2 units)
(5) early chest reexploration for excessive bleeding, tamponade, cardiac arrest, early graft malfunction or early valve malfunction
(6) sternal rewiring of a sterile dehiscence
where:
• If a patient was transferred between hospitals, then I would think the number of days between admission and surgery should be counted from the admission to the first hospital.
Additional factors identified on univariate analysis (Table 4):
(1) longer operations (noninfected 3.6 hours; infected 4.5 hours)
(2) longer period on cardiopulmonary bypass machine
(3) more complex post-operative course (longer time in ICU, more hours of mechanical ventilation)
Limitations:
• With modern cost containment it is unlikely that a patient would be in the hospital for 2 weeks prior to surgery.
