Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART

Author:

Kaspersen Alexander Emil12ORCID,Nielsen Susanne J34,Orrason Andri Wilberg5ORCID,Petursdottir Astridur6,Sigurdsson Martin Ingi78ORCID,Jeppsson Anders34ORCID,Gudbjartsson Tomas67

Affiliation:

1. Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark

2. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark

3. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

4. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

5. Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden

6. Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland

7. Faculty of Medicine, University of Iceland, Reykjavik, Iceland

8. Department of Anaesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland

Abstract

Abstract OBJECTIVES Deep sternal wound infection (DSWI) is a serious complication after open-heart surgery. We investigated the association between DSWI and short- and long-term all-cause mortality in a large well-defined nationwide population. METHODS A retrospective, nationwide cohort study, which included 114676 consecutive patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery from 1997 to 2015 in Sweden. Short- and long-term mortality was compared between DSWI patients and non-DSWI patients using propensity score inverse probability weighting adjustment based on patient characteristics and comorbidities. Median follow-up was 8.0 years (range 0–18.9). RESULTS Altogether, 1516 patients (1.3%) developed DSWI, most commonly in patients undergoing combined CABG and valve surgery (2.1%). DSWI patients were older and had more disease burden than non-DSWI patients. The unadjusted cumulative mortality was higher in the DSWI group compared with the non-DSWI group at 90 days (7.9% vs 3.0%, P < 0.001) and at 1 year (12.8% vs 4.5%, P < 0.001). The adjusted absolute difference in risk of death was 2.3% [95% confidence interval (CI): 0.8–3.9] at 90 days and 4.7% (95% CI: 2.6–6.7) at 1 year. DSWI was independently associated with 90-day [adjusted relative risk (aRR) 1.89 (95% CI: 1.38–2.59)], 1-year [aRR 2.13 (95% CI: 1.68–2.71)] and long-term all-cause mortality [adjusted hazard ratio 1.56 (95% CI: 1.30–1.88)]. CONCLUSIONS Both short- and long-term mortality risks are higher in DSWI patients compared to non-DSWI patients. These results stress the importance of preventing these infections and careful postoperative monitoring of DSWI patients.

Funder

Swedish Heart-Lung Foundation

Anders Jeppsson

Västra Götaland Region

University of Iceland Research Fund

Landspitali University Research Fund

Nils Winbergs fond

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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