Tracheostomy is Not a Risk Factor for Deep Sternal Wound Infection After Cardiac Surgery

doi:10.1016/j.athoracsur.2007.07.024

The Annals of Thoracic Surgery

Volume 84, Issue 6, December 2007, Pages 1984-1991

https://doi.org/10.1016/j.athoracsur.2007.07.024 Get rights and content

Background

Previous studies on predictors of deep sternal wound infection (DSWI) have identified either respiratory failure or tracheostomy as a risk factor for the occurrence of this complication. This study was conducted to analyze the interaction between these two variables. We hypothesize that respiratory failure and not tracheostomy per se is associated with an increased risk of DSWI.

Methods

We analyzed 2823 patients who underwent cardiac operations through median sternotomy between January 2002 and September 2006. Patients were divided into three groups: respiratory failure with or without tracheostomy (tracheostomy versus nontracheostomy) and patients without respiratory failure. The primary outcome measure was the incidence of DSWI in each group and its predictors.

Results

Postoperative respiratory failure was observed in 252 patients (9%): 144 without tracheostomy (57%) and 108 with tracheostomy (43%). The mean duration of intubation in nontracheostomy patients was 19 ± 12 days. The mean duration to tracheostomy was 13 ± 6 days. DSWI occurred in 38 patients (1.3%): patients with no respiratory failure, 1%; patients with respiratory failure, 5.1% (p < 0.001). The incidence of DSWI was similar between tracheostomy (4.6%) and nontracheostomy patients (5.6%, p = 0.5). The mean time to diagnosis of DSWI was 25 ± 14 days and was similar for all groups. The mean number of days to tracheostomy was 12 ± 3 days in DSWI patients and 13 ± 6 in patients without DSWI (p = 0.7). In multivariate analysis, respiratory failure was the strongest predictor of DSWI (odds ratio, 5.2). Tracheostomy was not identified as a predictor of DSWI or hospital mortality.

Conclusions

The incidence of DSWI remains high in patients with respiratory failure. Tracheostomy is not a risk factor for DSWI and serves as a surrogate for respiratory failure. Therefore, considering that early tracheostomy may be beneficial in patients with respiratory insufficiency, a more liberal approach to early tracheostomy may be warranted.

Section snippets

Material and Methods

We retrospectively analyzed a series of 2823 consecutive patients who underwent median sternotomy for cardiac operations at the Mount Sinai Medical Center between January 2002 and September 2006. Patients who underwent thoracic organ transplantation, ventricular assist device implantation, or a thoracotomy approach were not included in this analysis. The protocol was approved by our local Institutional Review Board and was compliant with HIPAA (Health Insurance Portability and Accountability

Results

The study included 2823 adult patients. Their mean age was 63 ± 14 years, 693 (25%) were older than 70 years, and 1744 (62%) were men. Postoperative respiratory failure was observed in 252 patients (9%). Patient demographics and the distribution of preoperative risk factors are summarized in Table 1.

The patients with respiratory failure differed from the patient population without respiratory failure in that they were older (p < 0.001), more likely to be women (p = 0.050), and presented more

Comment

We designed this study to establish whether tracheostomy is a risk factor for postoperative DSWI when the confounding variable of respiratory failure is controlled for. The main finding of this study is that respiratory failure—and not tracheostomy per se—is an independent predictor of DSWI. The timing of tracheostomy did not appear to alter this fact. Respiratory failure was the strongest independent risk factor for DSWI identified in our study, which demonstrated additional independent risk

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Original articleCardiovascularTracheostomy is Not a Risk Factor for Deep Sternal Wound Infection After Cardiac Surgery

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Chest

Chest

Chest

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Chest

Ann Thorac Surg

Ann Thorac Surg

Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models

Intensive Care Med

Original article
Cardiovascular
Tracheostomy is Not a Risk Factor for Deep Sternal Wound Infection After Cardiac Surgery