Risk factors for deep sternal wound infections after cardiac surgery in Jordan
Ibtisam M Al-Zaru
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorAli A Ammouri
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorMousa A Al-Hassan
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorAnas A Amr
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorIbtisam M Al-Zaru
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorAli A Ammouri
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorMousa A Al-Hassan
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorAnas A Amr
Authors: Ibtisam M Al-Zaru , PhD, RN, Assistant Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Ali A Ammouri , PhD, RN, MSN, Assistant Professor, School of Nursing, Hashemite University, Zarqa; Mousa A Al-Hassan , PhD, RN, Associate Professor, Faculty of Nursing, Jordan University of Science & Technology, Irbid; Anas A Amr , RN, MSN, Registered Nurse, King Abdullah University Hospital, Irbid, Jordan
Search for more papers by this authorAbstract
Aim. The purpose of this study was to assess rates of and risk factors for deep sternal wound infection after coronary artery bypass grafting surgery.
Background. Deep sternal wound infection is one of the most devastating complications of cardiac surgery, resulting in multiple operative and non-operative procedures and increased hospital costs.
Design. A retrospective design using an existing coronary artery surgery database of adults (n = 206) who had undergone coronary artery bypass grafting surgeries between January 2004–January 2006 at a university affiliated hospital, northern Jordan was used.
Method. Multiple logistic regression analyses were used to asses rates of and risk factors for deep sternal wound infection.
Results. Deep sternal wound infection incidence rate was 22% of the total sample. Risk factors of deep sternal wound infection include: (1) diabetes (OR = 0·317, p = 0·048), (2) Obesity (OR = 0·275, p = 0·011), (3) duration of surgery (OR = 4·22, p = 0·032) and (4) use of intraaortic balloon pump (OR = 0·033, p = 0·001).
Conclusion. The proposed model provides a preliminary indication of risk factors placing coronary artery bypass grafting patients at risk of DSWI. Further investigations and testing of the model are needed.
Relevance to clinical practice. Determining patients who are at risk of developing deep sternal wound infection after cardiac surgeries is the first step towards its prevention.
References
- Antunes PE, Bernardo JE, Egue′ nio L, De Olivera JF & Antunes MJ (1997) Mediastinitis after aorto-coronary bypass surgery. European Journal of Cardiothoracic Surgery 12, 443–449.
- Baskett RJ, Macdougall CE & Ross DB (1999) Is mediastinits a preventable complication? A 10 years review. Annals of Thoracic Surgery 67, 462–465.
- Birkmeyer N, Charlesworth DC, Hernandez F, Leavitt BJ, Marrin CA, Morton JR, Olmstead EM & O'Connor GT (1998) Obesity and risk of adverse outcome associated with coronary artery bypass surgery. Circulation 97, 1689–1694.
- Borger MA, Rao V, Weisel RD, Ivanovs J, Cohen G, Scully HE & David TE (1998) Deep Sternal wound infection: risk factors and outcomes. Annals of Thoracic Surgery 65, 1050–1056.
- Carrier M, Gregoire J, Tronc F, Cartier R, Leclerc Y & Pelletier LC (1992) Effect of internal mammary artery dissection on sternal vascularization. Annals of Thoracic Surgery 53, 115–119.
- Catarina YB, Eva M & Ulrika R (2000) Spread of Coagulase-Negative Staphylococci during cardiac operations in a modern operating room. Annals of Thoracic Surgery 69, 1110–1115.
- Cayci C, Russo M, Cheema F, Martens T, Ozcan V, Argenziano M, Oz MC & Ascherman J (2008) Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Annals of Plastic Surgery 61, 294–301.
- CDC (2006) Assessing risk factors for chronic disease – Jordan. Morbidity and Mortality Weekly Report 55, 653–655.
- Chelemer SB, Prato BS, Cox PM, O’Connor GT & Morton JR (2002) Association of bacterial infection and red blood cell transfusion after coronary artery bypass surgery. Annals of Thoracic Surgery 73, 138–142.
- De Feo M, Renzulli A, Ismeno G, Gregorio R, Della Corte A, Utili R & Cotrufo M (2001) Variables predicting adverse outcome in patients with deep sternal wound infection. Annals of Thoracic Surgery 71, 324–331.
- De Paulis R, De Notaris S, Scaffa R, Nardella S, Zeitani J, Del Giudice C, De Peppo AP, Tomai F & Chiariello L (2005) The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal wound infection. Journal of Thoracic and Cardiovascular Surgery 129, 536–543.
- Furnary AP, Zerr KJ, Grunkemeier GL & Starr A (1999) Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac procedures. Annals of Thoracic Surgery 67, 352–362.
- Garner JS, Jarvis WR & Emori TG (1988) Center for disease control and prevention: definitions for nosocomial infections. American Journal of Infection Control 16, 128–140.
- Guler M, Kirali K & Toker ME (2001) Different CABG methods in patients with chronic obstructive pulmonary disease. Annals of Thoracic Surgery 71, 152–157.
- Hollenbeak CS, Murphy DM & Koening S (2000) The clinical and economic impact of deep chest surgical site infection following coronary artery bypass graft surgery. Chest 118, 397–402.
- Hussey LC, Leeper B & Hynan LS (1998) Development of the sternal wound infection prediction scale. Heart and Lung 27, 326–336.
- Jaffe RA & Sammuels SI (1999) Anesthesiologist’s Manual of Surgical Procedures, 2nd edn. Philadelphia, Lippincott Williams & Wilkins.
- Jordan Ministry of Health (2005) Health Indicators. Available at: http://www.moh.gov.jo/head-page.htm (accessed February 2005).
- Khan J, Magnetti S, Davis E & Zhang J (2000) Late outcomes of open heart surgery in patients 70 years and older. Annals of Thoracic Surgery 69, 165–170.
- King Abdullah University Hospital (2005) King Abdullah University Hospital Statistical Report 2005. Irbid, Jordan.
- King RB, Rozanski A, Blumenthal JA & Kaplan J (2002) Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 99, 2192–2217.
- Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE & Sexton DJ (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization and extra costs. Infection Control and Hospital Epidemiology 20, 725–730.
- Ku C, Ku S, Yin J & Lee A (2005) Risk Factors for sternal and leg surgical site infections after cardiac surgery in Taiwan. American Journal of Epidemiology 161, 661–671.
- McConkey SJ, L′Ecuyer PB, Murphy DM, Leet TL, Sundt TM & Fraser VJ (1999) Results of a comprehensive infection control program for reducing surgical-site infections in coronary artery bypass surgery. Infection control and hospital epidemiology 20, 533–538.
- Milano CA, Kesler K, Archibald N, Sexton DJ & Jones RH (1995) Mediastinitis after coronary artery bypass surgery: risk factors and long-term survival. Circulation 92, 2245–2251.
- Olsen MA, Lock-Buckley P, Hopkins D, Polish LB, Sundt TM & Fraser VJ (2002) The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. Journal of Thoracic and Cardiovascular Surgery 124, 136–145.
- Orenstein A, Kachel F, Zuloff-Shani A, Paz Y, Sarig O, Haik J, Smolinsky AK, Mohr R, Shinar E & Danon D (2005) Treatment of deep sternal wound infections post-open heart surgery by application of activated macrophage suspension. Wound Repair and Regeneration 13, 237–242.
- Orhan G, Bicer Y, Aka SA, Sargin M, Simsek S, Senay S, Aykac Z & Eren EE (2004) Coronary artery bypass graft operations safely in obese patients. European Journal of Cardio-thoracic Surgery 25, 212–217.
- Schroeder MA (1990) Diagnosing and dealing with multicollinearity. Western Journal of Nursing Research 12, 175–187.
- Sethi GK, Copeland JG, Moritz T, Henderson W, Zadina K & Goldman S (1991) Comparison of postoperative complications between saphenous vein and IMA grafts to left anterior descending coronary arteries. Annals Thoracic Surgery 51, 733–738.
- Shaffer RB & Corish C (1998) Cardiac surgery and women. Journal of Cardiovascular Nursing 12, 14–31.
- Sofer D, Gurevitch J, Shapira I, Paz Y, Matsa M, Kramer A & Mohr R (1999) Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries. Annals of Surgery 229, 585–590.
- SPSS Base (2002) Version 12 for Windows User’s Guide. SPSS, Chicago.
- Swenne CL (2006). Wound infection following coronary artery bypass graft surgery: risk factors and the experiences of patients. Unpublished doctoral dissertation. Acta Universitatis Upsaliensis Uppsala.
- Thomas TA, Taylor SM, Crane MM, Cornett WR, Langan EM, Snyder BA & Cull DL (1999) An analysis of limb-threatening lower extremity wound complications after 1090 consecutive coronary artery bypass procedures. Vascular Medicine 4, 83–88.
- Toumpoulis IK, Anagnostopoulos CE, DeRose J & Swistel DJ (2005) The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest 127, 464–471.
- Troutman S, Hussey LC, Hynan L & Lucisano K (2001) Sternal wound infection prediction scale: a test of the reliability and validity. Nursing and Health Sciences 3, 1–8.
- Vaska PL (1993) Sternal wound infections. AACN Clinical Issues in Critical Care Nursing 4, 475–483.
- Vuorisalo S, Haukipuro K, Pokela R & Syrjala H (1998) Risk features for surgical-site infections in coronary artery bypass surgery. Infection Control and Hospital Epidemiology 19, 240–247.
- WHO (2006) Cardiovascular Disease: Prevention and Control. Available at: http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/ (accessed February 2006).
- Zacharias A & Habib RH (1996) Factors predisposing to median sternotomy complications: deep vs. superficial infection. Chest 110, 1173–1178.
- Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V & Starr A (1997) Glucose control lowers the risk of wound infection in diabetics after open heart surgery. Annals of Thoracic Surgery 63, 356–361.