Risk factors influencing the outcome after surgical treatment of complicated deep sternal wound complications.

摘要: Abstract Background : Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk deep sternal wound infections and/or dehiscence. In contrast to previous studies that examined factors this study evaluates lead poor outcome after surgical revision of non healing sternum. Methods Between 1985 and 1999, 193 adults (mean age 64 ± 9 years, m/f = 3/1) necessitated revisions (incidence 1.93%). Pre-, intra- post-operative were evaluated their influence on revision. Results 65 patients had complicated course: ten (5.2%) died due sepsis/multi organ failure ( n 6) or causes 4). 32 (16.6%) needed several revisions, 17 (9%) discharged with instability, 5 (3%) chronic fistula one persistent osteomyelitis. Univariate multivariate analysis identified cardiopulmonary resuscitation (odds ratio OR ) 11.188, p 0.010), corticoid treatment 7.043, 0.0055), diabetes 4.130, 0.0128), smoking history 2.996, 0.0041), renal insufficiency (hazard HR 1.884), old 1.108, 0.0266), high body mass 1.06), ECC time 0.023), cross clamp 0.028), systemic hypothermia 0.016), non-use IMA 0.042) prolonged ventilation as mortality outcome. No correlation between closure technique, mediastinal irrigation antibiotic therapy could be found. Conclusions To avoid disappointing results should aim preoperatively identify high-risk aggressively address factors. This rather than modifications medical approach might improve complications.