• Farzan Filsoufi, Javier G Castillo, Parwis B Rahmanian, Stafford R Broumand, George Silvay, Alain Carpentier, and David H Adams.
• Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029-1028, USA. farzan.filsoufi@mountsinai.org
• J. Cardiothorac. Vasc. Anesth. 2009 Aug 1; 23 (4): 488-94.

ObjectivesThe aim of this study was to investigate the incidence and predictors of deep sternal wound infection (DSWI) in a contemporary cohort of patients undergoing cardiac surgery. The early and late outcomes of patients with this complication also were analyzed.DesignA retrospective study of consecutive patients undergoing cardiac surgery using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively.SettingA university hospital (single institution).ParticipantsFive thousand seven hundred ninety-eight patients who underwent cardiac surgery between January 1998 and December 2005 including isolated coronary artery bypass graft (CABG) (n = 2,749, 47%), single- or multiple-valve surgery (n = 1,280, 22%), combined valve and CABG procedures (n = 934, 16%), and surgery involving the ascending aorta or the aortic arch (n = 835, 15%).InterventionsNone.Measurements And Main ResultsThe overall incidence of DSWI was 1.8% (n = 106). The highest rate of DSWI occurred after combined valve/CABG surgery (2.4%, n = 22) and aortic procedures (2.4%, n = 19). Multivariate analysis revealed 11 predictors of DSWI: obesity (odds ratio [OR] = 2.2), previous myocardial infarction (OR = 2.1), diabetes (OR = 1.7), chronic obstructive pulmonary disease (OR = 2.3), preoperative length of stay >3 days (OR = 1.9), aortic calcification (OR = 2.7), aortic surgery (OR = 2.4), combined valve/CABG procedures (OR = 1.9), cardiopulmonary bypass time (OR = 1.8), re-exploration for bleeding (OR = 6.3), and respiratory failure (OR = 3.2). The mortality rate was 14.2% (n = 15) versus 3.6% (n = 205) in the control group (p < 0.001). One- and 5-year survival after DSWI were significantly decreased (72.4% +/- 4.4% and 55.8% +/- 5.6% v 93.8% +/- 0.3% and 82.0% +/- 0.6%, p < 0.001).ConclusionDSWI remains a rare but devastating complication and is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival.

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