Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up

2.50
Hdl Handle:
http://hdl.handle.net/2336/86993
Title:
Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up
Authors:
Steingrimsson, Steinn; Gustafsson, Ronny; Gudbjartsson, Tomas; Mokhtari, Arash; Ingemansson, Richard; Sjögren, Johan
Citation:
Ann. Thorac. Surg. 2009, 88(6):1910-5
Issue Date:
1-Dec-2009
Abstract:
BACKGROUND: Sternocutaneous fistulas (SCFs) after cardiac surgery represent a complex surgical problem involving multiple hospital admissions, prolonged antibiotic treatment, and repeated debridements. Our objective was to identify the incidence of and risk factors for SCF, and to evaluate long-term survival. METHODS: A total of 12,297 patients underwent sternotomy for cardiac surgery between January 1999 and December 2008, and 32 patients were diagnosed as having SCF during follow-up. Risk factors were identified with multivariate analysis and survival was compared using the log-rank test. RESULTS: The cumulative incidence of SCF at one year was 0.23%. There was no significant difference in mean time from sternal closure after cardiac surgery to intervention for SCF with (n = 9) or without (n = 23) preceding sternal wound infection (SWI); 6.1 +/- 4.2 versus 6.9 +/- 4.6 months, (p = ns). Risk factors for developing SCF were previous SWI (odds ratio [OR] = 15.7), renal failure (OR = 12.5), smoking (OR = 4.7), and use of bone wax during cardiac surgery (OR = 4.2). Negative-pressure wound therapy was applied in 20 cases of extensive SCFs. Five-year survival of SCF patients was 58% +/- 1% as compared with 85% +/- 4% in the control group (p = 0.003). CONCLUSIONS: Sternocutaneous fistula is a devastating diagnosis with significant morbidity and mortality. Previous SWI, renal failure, smoking, and use of bone wax are major risk factors. However, in a majority of patients SCF is not preceded by SWI and our results indicate that SCF may be a foreign body infection that develops in susceptible patients with risk factors for poor wound healing. Negative-pressure wound therapy may be a valuable adjunct in the treatment of extensive SCF.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
http://dx.doi.org/10.1016/j.athoracsur.2009.07.012

Full metadata record

DC FieldValue Language
dc.contributor.authorSteingrimsson, Steinnen
dc.contributor.authorGustafsson, Ronnyen
dc.contributor.authorGudbjartsson, Tomasen
dc.contributor.authorMokhtari, Arashen
dc.contributor.authorIngemansson, Richarden
dc.contributor.authorSjögren, Johanen
dc.date.accessioned2009-11-27T09:40:31Z-
dc.date.available2009-11-27T09:40:31Z-
dc.date.issued2009-12-01-
dc.date.submitted2009-11-27-
dc.identifier.citationAnn. Thorac. Surg. 2009, 88(6):1910-5en
dc.identifier.issn1552-6259-
dc.identifier.pmid19932261-
dc.identifier.doi10.1016/j.athoracsur.2009.07.012-
dc.identifier.urihttp://hdl.handle.net/2336/86993-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: Sternocutaneous fistulas (SCFs) after cardiac surgery represent a complex surgical problem involving multiple hospital admissions, prolonged antibiotic treatment, and repeated debridements. Our objective was to identify the incidence of and risk factors for SCF, and to evaluate long-term survival. METHODS: A total of 12,297 patients underwent sternotomy for cardiac surgery between January 1999 and December 2008, and 32 patients were diagnosed as having SCF during follow-up. Risk factors were identified with multivariate analysis and survival was compared using the log-rank test. RESULTS: The cumulative incidence of SCF at one year was 0.23%. There was no significant difference in mean time from sternal closure after cardiac surgery to intervention for SCF with (n = 9) or without (n = 23) preceding sternal wound infection (SWI); 6.1 +/- 4.2 versus 6.9 +/- 4.6 months, (p = ns). Risk factors for developing SCF were previous SWI (odds ratio [OR] = 15.7), renal failure (OR = 12.5), smoking (OR = 4.7), and use of bone wax during cardiac surgery (OR = 4.2). Negative-pressure wound therapy was applied in 20 cases of extensive SCFs. Five-year survival of SCF patients was 58% +/- 1% as compared with 85% +/- 4% in the control group (p = 0.003). CONCLUSIONS: Sternocutaneous fistula is a devastating diagnosis with significant morbidity and mortality. Previous SWI, renal failure, smoking, and use of bone wax are major risk factors. However, in a majority of patients SCF is not preceded by SWI and our results indicate that SCF may be a foreign body infection that develops in susceptible patients with risk factors for poor wound healing. Negative-pressure wound therapy may be a valuable adjunct in the treatment of extensive SCF.en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.urlhttp://dx.doi.org/10.1016/j.athoracsur.2009.07.012en
dc.subject.meshPubMed in processen
dc.titleSternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-upen
dc.typeArticleen
dc.contributor.departmentDepartment of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.en
dc.identifier.journalAnnals of thoracic surgeryen

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