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Floyd D. Loop
Bruce W. Lytle
Delos M. Cosgrove
Robert W. Stewart
Paul C. Taylor
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Ann Thorac Surg 1990;49:179-187
© 1990 The Society of Thoracic Surgeons

Articles

Sternal wound complications after isolated coronary artery bypass grafting: Early and late mortality, morbidity, and cost of care

Floyd D. Loop, MD*, Bruce W. Lytle, MD, Delos M. Cosgrove, MD, Saade Mahfood, MD, Martin C. McHenry, MD, Marlene Goormastic, MPH, Robert W. Stewart, MD, Leonard A.R. Golding, MD, Paul C. Taylor, MD

Department of Thoracic and Cardiovascular Surgery, Department of Infectious Disease, and Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio USA

* Address reprint requests to Dr Loop, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Ave, Cleveland, OH 44195-5066.

Of 6,504 consecutive patients who underwent isolated coronary bypass grafting in 1985 to 1987, 72 (1.1%) patients experienced sternal wound complications. Ten patients (14%) with wound complications died of multi-system failure. Only the patients with negative cultures fated well; of the bacterial culture categories, polymicrobial infection carried the worst prognosis. Effect of recurring infection were seen throughout the first year. Patients, grouped according to conduits received, experienced these wound complication rates: vein grafts only, 11/1,085 (1.0%); one internal thoracic artery, 38/4,073 (0.9%); and bilateral internal thoracic artery grafts, 23/ 1,346 (1.7%), There were no significant differences in wound complication rates between primary and reoperation patients or among conduit groups. By logistic regression analysis, the relative risk for patients with diabetes and bilateral internal thoracic artery grafting was 5.00 (95% confidence interval, 2.4 to 10.5). Operation time as a continuous variable increased the relative risk of wound complication 1.47 times per hour (1.3 to 1.7); obesity, 2.90 times (1.8 to 4.8); and blood units as continuous variable, 1,05 times per unit (1.01 to 1.10). Bilateral internal thoracic artery grafting in nondiabetic patients carried no grsater risk of wound complication than that in patients with vein grafts only or with one internal thoracic artery graft.




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R. Sharma, D. Puri, B. P. Panigrahi, and I. S. Virdi
A modified parasternal wire technique for prevention and treatment of sternal dehiscence
Ann. Thorac. Surg., January 1, 2004; 77(1): 210 - 213.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. A. Tortoriello, J. D. Friedman, E. D. McKenzie, C. D. Fraser, T. F. Feltes, J. Randall, and A. R. Mott
Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution
Ann. Thorac. Surg., November 1, 2003; 76(5): 1655 - 1660.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
M. D. Peterson, M. A. Borger, V. Rao, C. M. Peniston, and C. M. Feindel
Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes
J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1314 - 1319.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
J. C. Y. Lu, A. D. Grayson, P. Jha, A. K. Srinivasan, and B. M. Fabri
Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery
Eur J Cardiothorac Surg, June 1, 2003; 23(6): 943 - 949.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
B. W. Lytle
Skeletonized internal thoracic artery grafts and wound complications
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S71 - 73.
[Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
D. Jonkers, T. Elenbaas, P. Terporten, F. Nieman, and E. Stobberingh
Prevalence of 90-days postoperative wound infections after cardiac surgery
Eur J Cardiothorac Surg, January 1, 2003; 23(1): 97 - 102.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
M. Doss, S. Martens, J. P. Wood, J. D. Wolff, C. Baier, and A. Moritz
Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis
Eur J Cardiothorac Surg, December 1, 2002; 22(6): 934 - 938.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. M. Fleck, M. Fleck, R. Moidl, M. Czerny, R. Koller, P. Giovanoli, M. J. Hiesmayer, D. Zimpfer, E. Wolner, and M. Grabenwoger
The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery
Ann. Thorac. Surg., November 1, 2002; 74(5): 1596 - 1600.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
G. Prabhakar, C. K. Haan, E. D. Peterson, L. P. Coombs, J. L. Cruzzavala, and G. F. Murray
The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons' database
Ann. Thorac. Surg., October 1, 2002; 74(4): 1125 - 1131.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
K. C. Bertin, R. S. Rice, D. B. Doty, and K. W. Jones
Repair of transverse sternal nonunions using metal plates and autogenous bone graft
Ann. Thorac. Surg., May 1, 2002; 73(5): 1661 - 1662.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
B. Gardlund, C. Y. Bitkover, and J. Vaage
Postoperative mediastinitis in cardiac surgery -- microbiology and pathogenesis
Eur J Cardiothorac Surg, May 1, 2002; 21(5): 825 - 830.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
P. Totaro, V. Borghetti, S. Lanzi, and G. Minzioni
Primary omental-flap surgery for post-sternotomy acute medistinitis
Eur J Cardiothorac Surg, April 1, 2002; 21(4): 765 - 765.
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 J. Thorac. Cardiovasc. Surg.Home page
M. Carrier, R. Marchand, P. Auger, Y. Hebert, M. Pellerin, L. P. Perrault, R. Cartier, D. Bouchard, N. Poirier, and P. Page
Methicillin-resistant Staphylococcus aureus infection in a cardiac surgical unit
J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 40 - 44.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
S. B. Chelemer, B. S. Prato, P. M. Cox Jr, G. T. O'Connor, and J. R. Morton
Association of bacterial infection and red blood cell transfusion after coronary artery bypass surgery
Ann. Thorac. Surg., January 1, 2002; 73(1): 138 - 142.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
L. Ridderstolpe, H. Gill, H. Granfeldt, H. ahlfeldt, and H. Rutberg
Superficial and deep sternal wound complications: incidence, risk factors and mortality
Eur J Cardiothorac Surg, December 1, 2001; 20(6): 1168 - 1175.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
B. W. Lytle and F. D. Loop
Superiority of Bilateral Internal Thoracic Artery Grafting: It's Been a Long Time Comin'
Circulation, October 30, 2001; 104(18): 2152 - 2154.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. J. Francel and N. T. Kouchoukos
A rational approach to wound difficulties after sternotomy: the problem
Ann. Thorac. Surg., October 1, 2001; 72(4): 1411 - 1418.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. J. Francel and N. T. Kouchoukos
A rational approach to wound difficulties after sternotomy: reconstruction and long-term results
Ann. Thorac. Surg., October 1, 2001; 72(4): 1419 - 1429.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
P. Schroeyers, F. Wellens, I. Degrieck, R. De Geest, F. Van Praet, Y. Vermeulen, and H. Vanermen
Aggressive primary treatment for poststernotomy acute mediastinitis: our experience with omental- and muscle flaps surgery
Eur J Cardiothorac Surg, October 1, 2001; 20(4): 743 - 746.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. Carrier, L. P. Perrault, M. Pellerin, R. Marchand, P. Auger, G. B. Pelletier, M. White, N. Racine, and D. Bouchard
Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment
Ann. Thorac. Surg., September 1, 2001; 72(3): 719 - 723.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. J. Curtis, N. C. Clark, C. A. McKenney, J. T. Walls, R. A. Schmaltz, T. L. Demmy, J. W. Jones, W. R. Wilson Jr, and C. C. Wagner-Mann
Tracheostomy: a risk factor for mediastinitis after cardiac operation
Ann. Thorac. Surg., September 1, 2001; 72(3): 731 - 734.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
R. Astudillo, J. Vaage, U. Myhre, A. Karevold, and B. Gardlund
Fewer reoperations and shorter stay in the cardiac surgical ward when stabilising the sternum with the Ley prosthesis in post-operative mediastinitis
Eur J Cardiothorac Surg, July 1, 2001; 20(1): 133 - 139.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
M. De Feo, R. Gregorio, A. Della Corte, C. Marra, C. Amarelli, A. Renzulli, R. Utili, and M. Cotrufo
Deep sternal wound infection: the role of early debridement surgery
Eur J Cardiothorac Surg, June 1, 2001; 19(6): 811 - 816.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
B. W. Lytle
Skeletonized internal thoracic artery grafts and wound complications
J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 625 - 627.
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 J. Thorac. Cardiovasc. Surg.Home page
M. Matsa, Y. Paz, J. Gurevitch, I. Shapira, A. Kramer, D. Pevny, and R. Mohr
Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus
J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 668 - 674.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
Y. Nakayama, R. Sakata, and M. Ura
Bilateral internal thoracic artery use for dialysis patients: does it increase operative risk?
Ann. Thorac. Surg., March 1, 2001; 71(3): 783 - 787.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. A. Schwann, R. H. Habib, A. Zacharias, G. L. Parenteau, C. J. Riordan, S. J. Durham, and M. Engoren
Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation
Ann. Thorac. Surg., February 1, 2001; 71(2): 521 - 530.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. De Feo, A. Renzulli, G. Ismeno, R. Gregorio, A. Della Corte, R. Utili, and M. Cotrufo
Variables predicting adverse outcome in patients with deep sternal wound infection
Ann. Thorac. Surg., January 1, 2001; 71(1): 324 - 331.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. H. Braxton, C. A.S. Marrin, P. D. McGrath, C. S. Ross, J. R. Morton, M. Norotsky, D. C. Charlesworth, S. J. Lahey, R. A. Clough, and G. T. O'Connor
Mediastinitis and long-term survival after coronary artery bypass graft surgery
Ann. Thorac. Surg., December 1, 2000; 70(6): 2004 - 2007.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
R. Saginur, D. Croteau, and M. G. Bergeron
Comparative efficacy of teicoplanin and cefazolin for cardiac operation prophylaxis in 3027 patients
J. Thorac. Cardiovasc. Surg., December 1, 2000; 120(6): 1120 - 1130.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. Iwakura, Y. Tabata, K. Nishimura, T. Nakamura, Y. Shimizu, M. Fujita, and M. Komeda
Basic fibroblast growth factor may improve devascularized sternal healing
Ann. Thorac. Surg., September 1, 2000; 70(3): 824 - 828.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
H. F. Berg, W. G.B. Brands, T. R. van Geldorp, M. F.Q. Kluytmans-VandenBergh, and J. A.J.W. Kluytmans
Comparison between closed drainage techniques for the treatment of postoperative mediastinitis
Ann. Thorac. Surg., September 1, 2000; 70(3): 924 - 929.
[Abstract] [Full Text] [PDF]

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 ChestHome page
C. S. Hollenbeak, D. M. Murphy, S. Koenig, R. S. Woodward, W. C. Dunagan, and V. J. Fraser
The Clinical and Economic Impact of Deep Chest Surgical Site Infections Following Coronary Artery Bypass Graft Surgery
Chest, August 1, 2000; 118(2): 397 - 402.
[Abstract] [Full Text] [PDF]


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