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Early-onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis
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  • Ramsey Elsayed,
  • Joseph N. Carey,
  • Robbin Cohen,
  • Mark Barr,
  • Craig Baker,
  • Vaughn Starnes,
  • Michael Bowdish
Ramsey Elsayed
University of Southern California Keck School of Medicine, University of Southern California (USC)
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Joseph N. Carey
University of Southern California Keck School of Medicine
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Robbin Cohen
University of Southern California Keck School of Medicine
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Mark Barr
University of Southern California Keck School of Medicine
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Craig Baker
University of Southern California Keck School of Medicine
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Vaughn Starnes
University of Southern California Keck School of Medicine
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Michael Bowdish
University of Southern California Keck School of Medicine
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Abstract

Objectives: To compare outcomes after the development of early (≤30 days) versus delayed (>30 days) deep sternal wound infection (DSWI) after cardiac surgery. Methods: Between 2005 and 2016, 64 patients were treated surgically for DSWI following cardiac surgery. Thirty-three developed early DSWI, while 31 developed late DSWI. Mean follow up was 34.1 ± 32.3 months. Results: Survival for the entire cohort at 1, 3, and 5 years was 93.9, 85.1, and 80.8%, respectively. DSWI diagnosed early and attempted medical management were strongly associated with overall mortality (hazard ratio (HR), 25.0 and 9.9; 95% confidence intervals (CI), 1.18-528 and 1.28-76.5; p-value 0.04 and 0.04, respectively). Survival was 88.1, 77.0, 70.6 and 100, 94.0 and 94.0% at 1,3, and 5 years in the early and late DSWI groups, respectively (Log-rank = 0.074). Those diagnosed early were more likely to have a positive wound culture (odds ratio (OR), 0.06, 95% CI 0.01-0.69, p=0.024) and diagnosed late were more likely to be female (OR 8.75, 95% CI 2.0-38.4, p=0.004) and require an urgent DSWI procedure (OR 9.25, 95% CI 1.86-45.9, p=0.007). Both early diagnosis of DSWI and initial attempted medial management were strongly associated with mortality (hazard ratio 7.48, 95% CI 1.38-40.4, p=0.019 and hazard ratio 7.76, 95% CI 1.67-35.9, p=0.009, respectively). Conclusions: Early aggressive surgical therapy for deep sternal wound infection after cardiac surgery results in excellent outcomes. Those diagnosed with DSWI early and have failed initial medical management have increased mortality.

Peer review status:IN REVISION

17 Jul 2020Submitted to Journal of Cardiac Surgery
18 Jul 2020Assigned to Editor
18 Jul 2020Submission Checks Completed
28 Jul 2020Reviewer(s) Assigned
11 Aug 2020Review(s) Completed, Editorial Evaluation Pending
19 Aug 2020Editorial Decision: Revise Major