Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up

The Annals of Thoracic Surgery
Steinn SteingrímssonJohan Sjögren

Abstract

Sternocutaneous fistulas (SCFs) after cardiac surgery represent a complex surgical problem involving multiple hospital admissions, prolonged antibiotic treatment, and repeated debridements. Our objective was to identify the incidence of and risk factors for SCF, and to evaluate long-term survival. A total of 12,297 patients underwent sternotomy for cardiac surgery between January 1999 and December 2008, and 32 patients were diagnosed as having SCF during follow-up. Risk factors were identified with multivariate analysis and survival was compared using the log-rank test. The cumulative incidence of SCF at one year was 0.23%. There was no significant difference in mean time from sternal closure after cardiac surgery to intervention for SCF with (n = 9) or without (n = 23) preceding sternal wound infection (SWI); 6.1 +/- 4.2 versus 6.9 +/- 4.6 months, (p = ns). Risk factors for developing SCF were previous SWI (odds ratio [OR] = 15.7), renal failure (OR = 12.5), smoking (OR = 4.7), and use of bone wax during cardiac surgery (OR = 4.2). Negative-pressure wound therapy was applied in 20 cases of extensive SCFs. Five-year survival of SCF patients was 58% +/- 1% as compared with 85% +/- 4% in the control group (p = 0.003). Sternocutan...Continue Reading

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Citations

Aug 8, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Maria Pia ToccoAntonio Perozzi
Jun 14, 2012·Interactive Cardiovascular and Thoracic Surgery·Steinn SteingrimssonTomas Gudbjartsson
Apr 27, 2010·The Annals of Thoracic Surgery·Khaled E Al-Ebrahim
Feb 14, 2015·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Lachmandath TewarieAres Krishna Menon
Apr 14, 2012·Scandinavian Journal of Infectious Diseases·Steinn SteingrímssonTomas Gudbjartsson
Apr 12, 2013·Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia·Ahmet C Ozdemir, Koray Aykut
Apr 23, 2016·Scandinavian Cardiovascular Journal : SCJ·Tomas GudbjartssonJoel Dunning
Aug 25, 2016·The Journal of Thoracic and Cardiovascular Surgery·Harold L LazarSteven Gordon
Sep 15, 2018·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Martin SimekPetr Nemec
Apr 2, 2015·The American Journal of Forensic Medicine and Pathology·Ipshita Kak, Vidhya Nair
Sep 21, 2013·Journal of Wound Care·M J Lamas, T Centella
Sep 8, 2020·Critical Care Clinics·Shruti JayakumarMarjan Jahangiri

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