Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Average rating
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Star rating
Your vote was cast
Thank you for your feedback
Thank you for your feedback
Authors
Steingrimsson, SteinnGustafsson, Ronny
Gudbjartsson, Tomas
Mokhtari, Arash
Ingemansson, Richard
Sjögren, Johan
Issue Date
2009-12-01
Metadata
Show full item recordCitation
Ann. Thorac. Surg. 2009, 88(6):1910-5Abstract
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 fieldAdditional Links
http://dx.doi.org/10.1016/j.athoracsur.2009.07.012ae974a485f413a2113503eed53cd6c53
10.1016/j.athoracsur.2009.07.012
Scopus Count
Collections
Related articles
- Epidemiology of deep sternal wound infection in cardiac surgery.
- Authors: Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, Adams DH
- Issue date: 2009 Aug
- Deep sternal wound infection after cardiac surgery: modality of treatment and outcome.
- Authors: Immer FF, Durrer M, Mühlemann KS, Erni D, Gahl B, Carrel TP
- Issue date: 2005 Sep
- Primary sternal plating in high-risk patients prevents mediastinitis.
- Authors: Song DH, Lohman RF, Renucci JD, Jeevanandam V, Raman J
- Issue date: 2004 Aug
- The impact of vacuum-assisted closure on long-term survival after post-sternotomy mediastinitis.
- Authors: Sjögren J, Nilsson J, Gustafsson R, Malmsjö M, Ingemansson R
- Issue date: 2005 Oct
- Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial.
- Authors: Schimmer C, Reents W, Berneder S, Eigel P, Sezer O, Scheld H, Sahraoui K, Gansera B, Deppert O, Rubio A, Feyrer R, Sauer C, Elert O, Leyh R
- Issue date: 2008 Dec