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Edward B. Savage
Eric J. Okum
R. Anthony Perez-Tamayo
Eric D. Peterson
Fred H. Edwards
Robert S.D. Higgins
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Ann Thorac Surg 2007;83:1002-1006
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Use of Both Internal Thoracic Arteries in Diabetic Patients Increases Deep Sternal Wound Infection

Edward B. Savage, MDa,*, Joshua D. Grab, MSb, Sean M. O’Brien, PhDb, Aman Ali, MDc, Eric J. Okum, MDc, R. Anthony Perez-Tamayo, MDc, Daniel S. Eiferman, MDc, Eric D. Peterson, MDb,d, Fred H. Edwards, MDe, Robert S.D. Higgins, MDc

a Department of Surgery, St. John’s Mercy Medical Center, St. Louis, Missouri
b Duke Clinical Research Institute, Durham, North Carolina
c Department of Cardiovascular-Thoracic Surgery, Rush University, Chicago, Illinois
d Department of Medicine, Duke University, Durham, North Carolina
e Department of Surgery, University of Florida, Jacksonville, Florida

Accepted for publication September 28, 2006.

* Address correspondence to Dr Savage, 621 S. New Ballas Rd, Suite R-7049, 625 South New Ballas Rd, St. Louis, MO 63141 (Email: chstcutter{at}aya.yale.edu).

Background: Use of both internal thoracic arteries has been limited in diabetic patients fearing an increased incidence of deep sternal wound infection. We analyzed this concern by querying The Society of Thoracic Surgeons Database.

Methods: Diabetic patients who had isolated coronary artery bypass graft surgery during 2002 to 2004 were included if they had no prior bypass surgery, two or more distal bypasses, and a left internal thoracic artery bypass. Group B (both internal thoracic arteries) was compared with group L (left internal thoracic artery only).

Results: The incidence of deep sternal wound infection for all patients undergoing isolated first-time bypass surgery was less than 1%. Of these, 120,793 patients met criteria for inclusion: group B, 1.4% (1732); and group L, 98.6% (119,061). Group B had a higher crude (unadjusted) deep sternal wound infection rate of 2.8% (49) versus 1.7% (1969; p = 0.0005) in group L, with an estimated odds ratio of 2.23 (95% confidence interval, 1.69 to 2.96). Group B had a similar crude mortality rate of 1.7% (30) versus 2.3% (2785; p = NS) in group L, with an estimated odds ratio of 1.110 (95% CI, 0.78 to 1.59; p = NS). Patients in group B were younger, mostly male, had a lower serum creatinine level, and were more often current smokers; less commonly, they were insulin dependent, diagnosed with pulmonary or vascular disease, or on dialysis. Other risk factors for deep sternal would infection included female gender, insulin dependence, peripheral vascular disease, recent infarction, body mass index exceeding 35 kg/m2, and use of blood products.

Conclusions: There is a significant increase in the incidence of deep sternal would infection in diabetic patients. This is further increased with the use of both internal thoracic arteries with no apparent short-term mortality difference.


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