Effect of Skeletonization of Bilateral Internal Thoracic Arteries on Deep Sternal Wound Infections.

Aged Coronary Artery Bypass / adverse effects Female Humans Incidence Logistic Models Male Mammary Arteries / surgery Middle Aged Sternum / surgery Surgical Wound Infection / epidemiology

Journal

The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R

Informations de publication

Date de publication:
02 2021
Historique:
received: 27 02 2020
revised: 01 04 2020
accepted: 04 05 2020
pubmed: 1 7 2020
medline: 13 2 2021
entrez: 30 6 2020
Statut: ppublish

Résumé

Bilateral internal thoracic arteries (BITA) coronary bypass grafting may improve long-term outcomes but is associated with increased deep sternal wound infections (DSWIs). We analyzed whether BITA skeletonization impacts DSWIs and operative mortality (OM) using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Primary, isolated, nonemergent/nonsalvage BITA patients (July 2017 to December 2018) in The Society of Thoracic Surgeons Adult Cardiac Surgery Database were divided into groups based on BITA harvesting technique: both skeletonized (ssBITA) and ≥1 nonskeletonized (Non-ssBITA). DSWI and OM observed-to-expected (O/E) ratios were compared using The Society of Thoracic Surgeons Perioperative Risk Models. ssBITA versus Non-ssBITA DSWI and OM adjusted odds ratios were calculated by multivariable logistic regression and corroborated by propensity score matching. We analyzed 11,269 patients (42.8% ssBITA, 57.2% Non-ssBITA, 770 hospitals, 1448 surgeons). The ssBITA group had a higher incidence of comorbidities and off-pump surgery. Overall incidences of DSWIs and OM were 0.98% (O/E ratio, 5.1) and 1.72% (O/E ratio, 1.4), respectively, and were 28% (P = .129) and 23% (P = .096) lower in ssBITA. The DSWI O/E ratio was highest (5.9) in Non-ssBITA and lowest in ss-BITA (4.1). After multivariable adjustment, ssBITA was associated with a decreased risk of DSWIs (adjusted odds ratio, 0.66; 95% confidence interval, 0.44-1.00; P = .05), with no difference in OM. These results were confirmed among 3884 propensity score-matched pairs. DSWIs increased sharply with increasing number of risk factors for DSWIs regardless of harvesting technique, with a trend for higher DSWIs among Non-ssBITA for all risk categories. The observed high O/E ratio indicates that BITA grafting is associated with increased risk of DSWIs. Risk-adjusted DSWI rate and a lower O/E ratio in ssBITA support the protective role of skeletonization.

Sections du résumé

BACKGROUND
Bilateral internal thoracic arteries (BITA) coronary bypass grafting may improve long-term outcomes but is associated with increased deep sternal wound infections (DSWIs). We analyzed whether BITA skeletonization impacts DSWIs and operative mortality (OM) using The Society of Thoracic Surgeons Adult Cardiac Surgery Database.
METHODS
Primary, isolated, nonemergent/nonsalvage BITA patients (July 2017 to December 2018) in The Society of Thoracic Surgeons Adult Cardiac Surgery Database were divided into groups based on BITA harvesting technique: both skeletonized (ssBITA) and ≥1 nonskeletonized (Non-ssBITA). DSWI and OM observed-to-expected (O/E) ratios were compared using The Society of Thoracic Surgeons Perioperative Risk Models. ssBITA versus Non-ssBITA DSWI and OM adjusted odds ratios were calculated by multivariable logistic regression and corroborated by propensity score matching.
RESULTS
We analyzed 11,269 patients (42.8% ssBITA, 57.2% Non-ssBITA, 770 hospitals, 1448 surgeons). The ssBITA group had a higher incidence of comorbidities and off-pump surgery. Overall incidences of DSWIs and OM were 0.98% (O/E ratio, 5.1) and 1.72% (O/E ratio, 1.4), respectively, and were 28% (P = .129) and 23% (P = .096) lower in ssBITA. The DSWI O/E ratio was highest (5.9) in Non-ssBITA and lowest in ss-BITA (4.1). After multivariable adjustment, ssBITA was associated with a decreased risk of DSWIs (adjusted odds ratio, 0.66; 95% confidence interval, 0.44-1.00; P = .05), with no difference in OM. These results were confirmed among 3884 propensity score-matched pairs. DSWIs increased sharply with increasing number of risk factors for DSWIs regardless of harvesting technique, with a trend for higher DSWIs among Non-ssBITA for all risk categories.
CONCLUSIONS
The observed high O/E ratio indicates that BITA grafting is associated with increased risk of DSWIs. Risk-adjusted DSWI rate and a lower O/E ratio in ssBITA support the protective role of skeletonization.

Identifiants

DOI: 10.1016/j.athoracsur.2020.05.044 PMID: 32599046 PMC: PMC7890569
pubmed: 32599046
pii: S0003-4975(20)30986-3
doi: 10.1016/j.athoracsur.2020.05.044
pmc: PMC7890569
mid: NIHMS1664103
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

600-606

Subventions

Organisme : NHLBI NIH HHS
ID : R01 HL152021
Pays : United States

Informations de copyright

Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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Auteurs

Thomas A Schwann (TA)

Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts. Electronic address: thomas.schwannmd@baystatehealth.org.

Mario F L Gaudino (MFL)

Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, New York.

Daniel T Engelman (DT)

Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts.

Art Sedrakyan (A)

Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, New York.

Dongze Li (D)

Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, New York.

Robert F Tranbaugh (RF)

Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, New York.

Robert H Habib (RH)

Society of Thoracic Surgeons Research Center, Chicago, Illinois.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Revascularisation myocardique › Pontage aortocoronarien › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de régression › Modèles logistiques › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Système cardiovasculaire › Vaisseaux sanguins › Artères › Artères thoraciques › Artères mammaires › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › Appareil locomoteur › Squelette › Cage thoracique › Sternum › Effect of Skeletonization of Bilateral...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Infection de plaie opératoire › Effect of Skeletonization of Bilateral...