Factors Associated with Post-Sternotomy Wound Infection: A Meta-Analysis
DOI:
https://doi.org/10.26911/Abstract
Background: Sternal wound infection is a serious complication following cardiac surgery, contributing to increased morbidity, mortality, and length of hospital stay. Obesity, diabetes mellitus, smoking habits, and re-operation are suspected to contribute to the incidence of post-sternotomy wound infections. This study aimed to estimate the magnitude of the influence of obesity, diabetes, smoking, and re-operation as risk factors for post-sternotomy wound infections.
Subject and Method: This study is a systematic review and meta-analysis. Articles were obtained from databases including PubMed, Google Scholar and ScienceDirect, limited to publications from 2015 to 2025. The keywords and MeSH terms used were: “sternotomy, AND sternal wound infection OR deep sternal wound infection OR surgical site infection, AND “obesity OR body mass index, AND diabetes mellitus OR hyperglycemia AND smoking OR tobacco use AND re-operation AND cardiac surgery”. Article selection was based on eligibility criteria defined using the PICO model: P = patients post-sternotomy; I = obesity, diabetes, smoking, re-operation; C = non-obese, non-diabetic, non-smokers, no re-operation; O = post-sternotomy wound infection. Only full-text articles with a cross-sectional study design were included. Data were analyzed using RevMan version 5.3.
Results: A total of 16 articles were included in this meta-analysis, originating from Finland, Denmark, Australia, Saudi Arabia, Colombia, Italy, France, China, Pakistan, Brazil, and United States. The meta-analysis showed that the risk of post-sternotomy wound infection was significantly increased in patients with obesity (aOR = 1.50; 95% CI: 1.31–1.72; p < 0.001), diabetes (aOR = 2.02; 95% CI: 1.26–3.25; p = 0.004), smoking (aOR = 2.44; 95% CI: 1.36–2.27; p = 0.05), obstructive sleep apnea (aOR = 1.76; 95% CI: 1.36–2.27; p < 0.001), and re-operation (aOR = 2.90; 95% CI: 1.49–5.64; p = 0.002). All findings were statistically significant.
Conclusion: Risk of sternal wound infection post-sternotomy significantly increases with obesity, diabetes, smoking, and re-operation.
How to Cite
References
Ali U, Bibo L, Pierre M, Bayfield N, Raichel L, Merry C, Larbalestier R (2020). Deep Sternal Wound Infections After Cardiac Surgery: A New Australian Tertiary Centre Experience. Heart Lung Circ. 29(10):1571–1578. DOI: 101016/jhlc202002003
Biancari F, Gattai G, Rosato S, Mariscalco G, Pappalardo A, Onorati F, Faggian G, et al., (2020). Preoperative risk stratification of deep sternal wound infection after coronary surgery. Infect Control Hosp Epidemiol. 41(4): 444–451. DOI: 101017/ice2019375
Brunet A. N’Guyen Y, Lefebvre A, Poncet A, Robbins A, Bajolet O, Rubin S (2020) Obesity and preoperative anaemia as independent risk factors for sternal wound infection after coronary artery bypass graft surgery with pedicled (non-skeletonized) internal mammary arteries: the role of thoracic wall ischemia?. Vasc Health Risk Manag. 553-559.
Chen Y, He F, Wu F, Hu X, Zhang W, Li S, Guan H (2024). Developing a calculable risk prediction model for sternal wound infection after median sternotomy: a retrospective study. Burns Trauma. 13(12). DOI: 10.1093-/burnst/tkae031
Fu RH, Weinstein AL, Chang MM, Argenziano M, Ascherman JA, Rohde CH (2016). Risk factors of infected sternal wounds versus sterile wound dehiscence. J. Surg. Res. 200(1), 400–407. DOI: 101016/jjss201507045
Gatti G, Perrotti A, Reichart D, Maschietto L, Onorati F, Chocron S, Dalén M, et al. (2016). Glycated Hemoglobin and Risk of Sternal Wound Infection After Isolated Coronary Surgery. Circ J. 81(1): 36–43. DOI: 101253/circjCJ-16-0778.
Gundestrup L, Florczak CK, Riber LPS (2023). Factors associated with deep sternal wound infection after open-heart surgery in a Danish registry. Am Heart J Plus. 31: 100307. DOI: 101016/jahjo2023100307
Isaac AA (2023). Predictors of sternal wound infection post cardiac surgery in a Saudi Centre: a case control study. J. Cardiothorac. Surg. 18(1) 28.
Lemaignen A, Birgand G, Ghodhbane W, Alkhoder S, Lolom I, Belorgey S, Lucet JC (2015). Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation. Clin Microbiol Infect. 21(7): 674-e11.
Ma X, Chen D, Liu J, Wang W, Feng Z, Cheng N, Chen Y (2024) Risk factors for sternal wound infection after median sternotomy: A nested case–control study and time‐to‐event analysis. Int. Wound J. 21(7): e14965.
Majid FM, Buba FM, Barry M, Alsharani F, Alfawzan F (2020) Incidence types and outcomes of sternal wound infections after cardiac surgery in Saudi Arabia: A retrospective medical chart review. Saudi Med. J. 41(2): 177–182. DOI: 1015537/smj2020224843
Ohira S, Miyata H, Yamazaki S, Numata S, Motomura N, Takamoto S, Yaku H (2019). Deep sternal wound infection after bilateral internal thoracic artery grafting: Insights from a Japanese national database. J Thorac Cardiovasc Surg. 157(1): 166–173e1. DOI: 101016/jjtcvs201806101
Pan L, Mo R, Zhou Q, Wang D (2017). Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study. J. Thorac. Dis. 9(9): 3031–3037. DOI: 1021037/jtd20170841.
Rochayati N, Lestari P, Handayani S (2023). Factors that influence the length of stay in patients after Coronary Artery Bypass Graft surgery (CABG) (in Indonesia). J. Holistik Kesh. 17(2): 158-171.
Sa MPBO, Ferraz PE, Soares AF, Miranda RGA, Araújo ML, Silva FV, Lima RC (2017). Development and Validation of a Stratification Tool for Predicting Risk of Deep Sternal Wound Infection after Coronary Artery Bypass Grafting at a Brazilian Hospital. Braz J Cardiovasc Surg. 32(1), 1–7. DOI: 1021470/1678-9741-2016-0030.
Theodore DA, Goodwin RD, Zhang Y, Schneider N, Gordon RJ, (2019). History of depression and increased risk of sternal wound infection after cardiothoracic surgery: a novel and potentially modifiable risk factor. In Open Open Forum Infect. Dis. 6(3) p ofz083) US: Oxford University Press.
Yang J, Zhang B, Qu C, Liu L, Song Y (2022). Analysis of Risk Factors for Sternal Wound Infection After Off-Pump Coronary Artery Bypass Grafting Infection and drug resistance. 15, 5249–5256. DOI: 102147/IDRS¬3814¬22.
1.jpg)
