Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery
Abstract
:1. Introduction
2. Materials and Methods
- Purulent secretion from the wound.
- Swab culture isolated from the wound.
- Sternal instability with chest pain and fever (>38.5 °C).
- Mediastinitis or bone necrosis.
- Surgery performed under cardio-pulmonary bypass.
- Minimally invasive direct coronary artery bypass (MIDCAB) grafting.
- Off pump coronary artery bypass (OPCAB) grafting.
- Minimally invasive mitral valve repair/replacement.
- Minimally invasive aortic valve replacement.
2.1. Data Collection
2.2. Outcome Analysis
2.3. Ethics
2.4. Statistical Methods
3. Results
3.1. Baseline and Preoperative Data
3.2. Intraoperative Data
3.3. Wound Revision Data
3.4. Primary and Secondary Outcomes
4. Discussion
5. Conclusions
6. Study Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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before PSM | after PSM | |||||
---|---|---|---|---|---|---|
Male (n = 150) | Female (n = 67) | p-Value | Male (n = 62) | Female (n = 62) | p-Value | |
Age (years), mean ± SD | 63 ± 12 | 66 ± 12 | 0.606 | 64 ± 11 | 66 ± 13 | 0.088 |
BMI (kg/m2), mean ± SD | 28.6 ± 5.0 | 29.0 ± 7.4 | 0.007 | 29.7 ± 5.2 | 29.4 ± 7.3 | 0.905 |
Diabetes, n (%) | 66 (44.0%) | 36 (53.7%) | 0.293 | 32 (51.6%) | 33 (53.2%) | 0.857 |
Hyperlipidemia, n (%) | 118 (78.7%) | 58 (86.6%) | 0.347 | 46 (74.2%) | 53 (85.5%) | 0.117 |
Arterial hypertension, n (%) | 136 (90.7%) | 62 (92.5%) | 0.761 | 56 (90.3%) | 57 (91.9%) | 0.752 |
Smoker, n (%) | 73 (48.7%) | 25 (37.3%) | 0.290 | 29 (46.8%) | 22 (35.5%) | 0.229 |
COPD, n (%) | 31 (20.7%) | 12 (17.9%) | 0.882 | 15 (24.2%) | 12 (19.4%) | 0.218 |
PVD, n (%) | 22 (14.8%) | 16 (23.9%) | 0.261 | 10 (16.1%) | 15 (24.2%) | 0.135 |
Renal insufficiency, n (%) | 40 (26.7%) | 15 (22.7%) | 0.274 | 16 (25.8%) | 15 (24.2%) | 0.597 |
before PSM | after PSM | |||||
---|---|---|---|---|---|---|
Male (n = 150) | Female (n = 67) | p-Value | Male (n = 62) | Female (n = 62) | p-Value | |
CABG, n (%) | 111 (74.0%) | 40 (59.7%) | 0.362 | 44 (71.0%) | 37 (59.7%) | 0.186 |
Heart valve surgery, n (%) | 39 (26.0%) | 27 (40.2%) | 0.052 | 18 (29.0%) | 25 (40.3%) | 0.073 |
Urgent procedure, n (%) | 30 (20.1%) | 13 (19.4%) | 0.769 | 10 (16.1%) | 11 (17.7%) | 0.811 |
CPR before surgery, n (%) | 7 (4.7%) | 0 (0.0%) | 0.071 | 3 (4.8%) | 0 (0.0%) | 0.244 |
Reoperation, n (%) | 9 (6.1%) | 1 (1.5%) | 0.126 | 2 (3.2%) | 1 (1.6%) | 0.346 |
Use of left ITA graft, n (%) | 125 (83.3%) | 53 (80.3%) | 0.360 | 47 (75.8%) | 49 (80.3%) | 0.545 |
Use of both ITA graft, n (%) | 53 (35.3%) | 14 (20.9%) | 0.023 | 15 (24.2%) | 14 (22.6%) | 0.832 |
Bone wax, n (%) | 71 (48.3%) | 26 (39.4%) | 0.480 | 23 (37.1%) | 25 (41.0%) | 0.811 |
CPB time (min), mean ± SD | 96.4 ± 60.3 | 96.5 ± 48.3 | 0.193 | 97 ± 52 | 99 ± 46 | 0.505 |
CC time (min), mean ± SD | 57.6 ± 41.7 | 60.0 ± 32.6 | 0.425 | 58 ± 35 | 61 ± 33 | 0.749 |
before PSM | after PSM | |||||
---|---|---|---|---|---|---|
Male (n = 150) | Female (n = 67) | p-Value | Male (n = 62) | Female (n = 62) | p-Value | |
HbA1c, %, mean ± SD | 6.8 ± 1.5 | 7.1 ± 1.4 | 0.686 | 6.5 ± 1.5 | 7.0 ± 1.4 | 0.667 |
CRP mg/L, mean ± SD | 93.4 ± 85.8 | 94.4 ± 83.9 | 0.969 | 104 ± 90 | 97 ± 83 | 0.676 |
Leukocytes 10×9/L, mean ± SD | 10.1 ± 4.4 | 10.0 ± 3.3 | 0.090 | 9.4 ± 3.8 | 9.4 ± 3.6 | 0.653 |
Wound secretion, n (%) | 28 (20.4%) | 10 (16.4%) | 0.563 | 13 (22.4%) | 9 (16.1%) | 0.391 |
Sternal instability, n (%) | 77(56.2%) | 36 (59.0%) | 0.417 | 29 (50.9%) | 32 (57.1%) | 0.504 |
Sternal wire removal, n (%) | 72 (53.7%) | 28 (46.7%) | 0.225 | 38 (61.2%) | 25 (40.3%) | 0.032 |
Direct wound closure, n (%) | 32 (23.4%) | 9 (14.8%) | 0.116 | 11 (17.7%) | 10 (16.1%) | 0.125 |
VAC therapy, n (%) | 105 (76.6%) | 52 (85.2%) | 0.188 | 51 (82.3%) | 52 (83.9%) | 0.432 |
VAC therapy, days, median ± SD | 17 ± 13 | 16 ± 14 | 0.265 | 18 ± 14 | 17 ± 15 | 0.324 |
before PSM | after PSM | |||||
---|---|---|---|---|---|---|
Male (n = 150) | Female (n = 67) | p-Value | Male (n = 62) | Female (n = 62) | p-Value | |
MV, hours, mean ± SD | 90.3 ± 27.2 | 39.0 ± 53.7 | 0.005 | 35 ± 50 | 39 ± 55 | 0.527 |
Tracheotomy, n (%) | 9 (6.1%) | 0 (0.0%) | 0.033 | 2 (3.25) | 0 (0.0%) | 0.496 |
Postoperative delirium, n (%) | 36 (24.5%) | 11 (16.9%) | 0.221 | 16 (25.8%) | 11 (18.3%) | 0.386 |
Acute renal failure, n (%) | 41 (27.7%) | 8 (12.1%) | 0.013 | 21 (33.9%) | 8 (13.1%) | 0.010 |
Dialysis, n (%) | 8 (5.4%) | 5 (7.6%) | 0.547 | 3 (4.8%) | 5 (8.2%) | 0.491 |
ICU stay, days, mean ± SD | 7 ± 9 | 5 ± 4 | 0.004 | 6 ± 7 | 4 ± 3 | 0.179 |
Hospital stay, days, mean ± SD | 29 ± 13 | 20 ± 14 | 0.087 | 29 ± 12 | 19 ± 14 | 0.093 |
In-hospital mortality, n (%) | 5 (3.4%) | 2 (3.0%) | 0.622 | 3 (4.8%) | 2 (3.3%) | 0.680 |
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Krasivskyi, I.; Ivanov, B.; Eghbalzadeh, K.; Fehlau, F.; Gerfer, S.; Großmann, C.; Elderia, A.; Sabashnikov, A.; Rahmanian, P.B.; Mader, N.; et al. Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery. J. Clin. Med. 2022, 11, 7510. https://doi.org/10.3390/jcm11247510
Krasivskyi I, Ivanov B, Eghbalzadeh K, Fehlau F, Gerfer S, Großmann C, Elderia A, Sabashnikov A, Rahmanian PB, Mader N, et al. Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery. Journal of Clinical Medicine. 2022; 11(24):7510. https://doi.org/10.3390/jcm11247510
Chicago/Turabian StyleKrasivskyi, Ihor, Borko Ivanov, Kaveh Eghbalzadeh, Frederike Fehlau, Stephen Gerfer, Clara Großmann, Ahmed Elderia, Anton Sabashnikov, Parwis Baradaran Rahmanian, Navid Mader, and et al. 2022. "Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery" Journal of Clinical Medicine 11, no. 24: 7510. https://doi.org/10.3390/jcm11247510