Evaluation of treatment outcomes and risk factors in patients with sternal wound infection after surgical myocardial revascularization

Ciljevi istraživanja: Određivanje ukupnog broja pacijenata, njihovog spola i dobi, broja pacijenata koji su postoperativno razvili infekciju sternalne rane te utvrđivanje rezultata liječenja infekcija sternalne rane. Nacrt studije: Istraživanje je retrospekivno. Ispitanici i metode: Pregled povijesti bolesti, operacijskih lista i otpusnih pisama svih pacijenata podvrgnutih kirurškoj revaskularizaciji miokarda u Kliničkom bolničkom centru u Osijeku na Odjelu za kardijalnu kirurgiju od 1. siječnja 2010. do 31. prosinca 2014. godine. Rezultati: Od ukupno 793 ispitanika 592 bilo je muškog spola, a 201 ženskog. 79,1 % pacijenata operirano je uz upotrebu stroja za izvantjelesni krvotok, a 20,9 % bez upotrebe stroja za izvantjelesni krvotok. Najveći broj pacijenata dobio je tri premosnice. 29 pacijenata (3,7 %) nakon kirurške revaskularizacije miokarda imalo je smrtni ishod. Infekciju sternalne rane nakon operacije razvilo je 85 pacijenata (10,7 %). Postojala je statistički značajna razlika u učestalosti infekcije ovisno o broju ugrađenih premosnica i vrijednosti EuroSCORE-a. Među pacijentima s infekcijom njih 74,1 % imalo je pozitivan bris. 60,0 % ih je prema Emory klasifikacijskom sustavu imalo površinsku infekciju, a 40,0 % duboku infekciju. U terapiji pacijenata s infekcijom sternalne rane kod 29 pacijenata korišten je VAC uređaj, a 14 pacijenata reoperirano je zbog nestabilnosti sternuma. Smrtnost pacijenata s infekcijom sternalne rane iznosila je 0,0 %. Zaključak: Veći broj operiranih pacijenata bili su muškarci, češće je primjenjivana kirurška revaskularizacija miokarda uz uporabu stroja za izvantjelesni krvotok, pacijenti s infekcijom sternalne rane imali su značajno više vrijednosti EuroSCORE-a, svi pacijenti s infekcijom sternalne rane izliječeni su.Objectives: To determine the total number of patients, their gender and age, the number of patients who developed postoperative sternal wound infection and to establish the results of the sternal wound infections treatment. Study Design: Retrospective study. Methods and participants: Review of medical history, surgical lists and hospital discharge forms for all patients who have undergone surgical myocardial revascularization in the Clinical Hospital Centre in Osijek at the Department of Cardiac Surgery from January 1st 2010 to December 31st 2014. Results: Out of 793 participants involved, 592 were males and 201 females. 79.1 % surgical myocardial revascularizations were done using an on-pump coronary artery bypass graft while 21.9 % were done off-pump coronary artery bypass. Most patients received three bypasses. 29 patients (3.7 %) had a lethal outcome after surgical myocardial revascularization. After surgery 85 patients (10.7 %) have developed sternal wound infection. There was a statistically significant difference in the incidence of infections depending on the number of performed bypasses and EuroSCORE values. Among patients with infection, 74.1 % of them had a positive microbiological smear. According to Emory classification system 60.0 % of them had a superficial infection and 40.0 % deep infection. In the treatment of patients with sternal wound infection in 29 patients (34.1 %) was used VAC system and 14 patients (16.5 %) were reoperated due to the instability of the sternum. Mortality of patients with sternal wound infection was 0.0 %. Conclusion: Of the total number of patients there were more males involved. Surgical revascularization using an on-pump coronary artery bypass graft was applied more often, and patients with sternal wound infection had significantly higher EuroSCORE values. All patients with sternal wound infection were healed