Methods for elimination of sternal infections in cardiac surgery. Comparative analysis of the outcomes
Abstract Recent studies have shown that elimination of infections in cardiac surgery remains to be one of the most challenging issues since it demands for a complex approach to the quality of the whole process of patient management starting from admission to the hospital.
Aim – to compare the outcomes of methods for sternal wound infections elimination and those of a standard method of cardiovascular surgeries.
Material and methods. During the period from January 2013 to July 2015 216 patients were enrolled into the study and allocated into 3 groups. The first group included 76 patients operated by a standard cardiac surgical algorithm (from January to December 2013). Sixty eight patients operated by the method of sternal wound infection elimination offered by P. Vogt were included into group two (from January 2014 to December 2014). The major peculiarities of the method developed by P. Vogt are as follows: minimum injury to subcutaneous fat, deletion of electric coagulation during sternotomy and chest closure; refusal to use wax for hemostasis in spongy sternal bone; stabilization of the sternum by application of 6–8 Z-like wire stitches; selective use of broad-spectrum antibiotics including those administered locally before the surgery. Group three included 72 patients operated with partial application of recommendations described in P. Vogt method (from November 2014 to July 2015). The most important differences were: the skin was not treated preoperatively; electrical coagulation was used during sternotomy; sternotomy was performed with a cold-plasma sternotome; the internal mammary artery (IMA) was either skeletonized or pedicled with no attempts to preserve IMA bifurcation; the spongy substance was not treated with vancomycin prior to the closure. The skin was sewn with interrupted sutures. In all the cases left pleural space was opened and its parietal part was used to close pericardium; a drainage window was left open in the LV apex.
Results. In group 1 there were 4 patients (5.2%) with superficial sternal wound infection proved with laboratory data. No cases of superficial sternal wound infection were registered in groups 2 and 3. One patient (1.3%) from group 1 suffered from deep sternal wound infection while patients in groups 2 and 3 were free from it. Eight repeated osteosyntheses (10.5%) were performed in patient group 1, and one (1.4%) – in group 2.
Conclusions. The method of elimination of sternal wound infection developed and launched by P.Vogt reduces the number of infectious complications from 6.5 to 0%.
Keywords:sternal wound infection, risk factors, infections in cardiac surgery
Clin. Experiment. Surg. Petrovsky J. 2016. № 2. Р. 51–59.
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