The effectiveness of the introduction of a system for the prevention of sternal complications in cardiac surgery
A. A. Shevchenko,
E. E. Kobzev,
K. P. Topalov,
E. A. Kashkarov,
E. V. Rosseikin,
N. G. Zhila,
I. A. Karpov https://doi.org/10.25789/YMJ.2024.85.08
Abstract
The aim of the study. To evaluate the results of the introduction of a system for the prevention of sternal infectious complications at the Federal Center for Cardiovascular Surgery in Khabarovsk in comparison with the traditional method of cardiac surgery.
Materials and methods. The authors conducted a comparative analysis of two treatment groups of cardiac surgery patients operated with sternotomy median access. The first group, 2712 patients operated according to the traditional method (2016-2018); the second group of patients, 2991 people, were treated using the method of prevention of sternal infectious complications (2019-2021). Attention was paid to the performance of bimammary bypass surgery, which is one of the leading risk factors for complications, while performing this type of bypass surgery increased in the second group.
Results. As a result of the introduction of systemic prevention of complications during cardiac surgery, the number of superficial complications, such as divergence of wound edges, skin necrosis, osteomyelitis of the sternum significantly decreased from 1.18±0.207 to 0.43±0.120% (t=3.11), there was also a tendency to decrease deep complications, namely sternomediastinitis - from 0.55± 0.142 to 0.23±0.088% (t=1.90).
Conclusion. The introduction of a system for the prevention of sternal complications in the work of cardiac surgeons during median sternotomy has reduced the incidence of postoperative sternomediastinitis and superficial complications. Therefore, in order to reduce infectious complications after cardiac surgery, it is advisable to introduce systemic prevention of sternal infection more widely into clinical practice.
About the Authors
A. A. Shevchenko
Far Eastern State Medical University; Regional clinical hospital No.1
Russian Federation
Russian Federation
SHEVCHENKO Alexander Alexandrovich – Ph.D., Associate Professor; thoracic surgeon of the highest qualification category
E. E. Kobzev
Federal Center for Cardiovascular Surgery
Russian Federation
Russian Federation
KOBZEV Evgeny Yevgenyevich – cardiovascular surgeon, head of the department
Khabarovsk
K. P. Topalov
Institute of Advanced Training of Healthcare Spesialists, Special-Medical Skills; RCH No.1
Russian Federation
Russian Federation
TOPALOV Klimentin Petrovich – Ph.D., Associate Professor; clinical head of the department
E. A. Kashkarov
RCH No. 1
Russian Federation
Russian Federation
KASHKAROV Yevgeny Alexandrovich – doctor of the highest qualification category, head of the department
E. V. Rosseikin
Far Eastern State Medical University
Russian Federation
Russian Federation
ROSSEIKIN Yevgeny Vladimirovich – MD, Chief Physician of the Federal Center for Cardiovascular Surgery, research associate
N. G. Zhila
St. Petersburg State Pediatrician University MH RF
Russian Federation
Russian Federation
ZHILA Nikolay Grigorievich – prof.
I. A. Karpov
Far Eastern State Medical University
Russian Federation
Russian Federation
KARPOV Ilya Andreyevich – clinical intern
References
1. Iyablonskiy P.K. [et al.]. Nacional'nye klinicheskie rekomendacii. Torakal'naya hirurgiya [National clinical guidelines. Thoracic surgery. Moscow : GEOTAR-Media, 2014:160 (In Russ.).].
2. Porhanov V.A., Pechetov A.A., Mitish V.A. [et al.]. Klinicheskie rekomendacii po hirurgicheskomu lecheniyu bol'nyh posleoperacionnym mediastinitom i osteomielitom grudiny i reber: metodich. rekomendacii dlya vrachej [Clinical recommendations for surgical treatment of patients with postoperative mediastinitis and osteomyelitis of the sternum and ribs: Methodological recommendations for doctors. Krasnodar Moscow, 2014; 25 (In Russ.).]
3. Al-Ebrahim K, Al-Ebrahim E Prevention, Classification and Management Review of Deep Sternal Wound Infection Heart. The Heart Surgery Forum. 2020 Sep;14;23(5):E652-E657. doi: 10.1532/hsf.3153.
4. Colombier S, Kessler U, Ferrari E, von Segesser LK, Berdajs DA. Influence of deep sternal wound infection on long-term survival after cardiac surgery. Medical Science Monitor. 2013 Aug;14;19:668-73. doi: 10.12659/ MSM.889191.
5. Gatti G, Benussi B, Brunetti D, Ceschia A, Porcari A, Biondi F, Castaldi G, Luzzati R, Sinagra G, Pappalardo A. The fate of patients having deep sternal infection after bilateral internal thoracic artery grafting in the negative pressure wound therapy era. International Journal of Cardiology. 2018 Oct;15;269:67-74. doi: 10.1016/j. ijcard.2018.07.090.
6. Hawkins RB, Mehaffey JH, Charles EJ, Krebs ED, Smith JG, Kern JA, Wanchek T, Teman NR. Cost-Effectiveness of Negative Pressure Incision Management System in Cardiac Surgery. J Surg Res. 2019 Aug;240:227-235. doi: 10.1016/j.jss.2019.02.046. Epub 2019 Apr 15.
7. Hernandez R, Lehr E.J. Mortality following deep sternal wound infection-not just a short-term complication? Eur J Cardiothorac Surg. 2021 Apr:11;ezab156. doi: 10.1093/ejcts/ezab156. Online ahead of print.
8. Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. Journal of Thoracic and Cardiovascular Surgery. 2016 Oct;152(4):962-72. doi: 10.1016/j.jtcvs.2016.01.060.
9. Lee G.S., Bisleri G, Tam D.Y. Deep Sternal Wound Infections: One Bad Cut, a Lifetime of Trouble Ann Thorac Surg. 2023 Jan;115(1):280281. doi: 10.1016/j.athoracsur.2022.05.044. Epub 2022 Jun 11.
10. Kirmani BH, Jones SG, Datta S, Mclaughlin EK, Hoschtitzky AJ. A meta-analysis of platelet gel for prevention of sternal wound infections following cardiac surgery. Blood Transfus. 2017 Jan;15(1):57-65. doi: 10.2450/2016.0231-15. Epub 2016 Apr 28.
11. Pradeep A, Rangasamy J, Varma PK, Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing. Medicinal Research Reviews. 2021 Mar;41(2):709-724. doi: 10.1002/med.21758.
12. Schwann TA, Gaudino MFL, Engelman DT, Sedrakyan A, Li D, Tranbaugh RF, Habib RH. Effect of Skeletonization of Bilateral Internal Thoracic Arteries on Deep Sternal Wound Infections. The Annals of Thoracic Surgery. 2021 Feb;111(2):600-606. doi: 10.1016/j.athoracsur.2020.05.044.
13. Vestergaard RF, Bruel A, Thomsen JS, Bruel A, Hauge EM, Sobale K, Hasenkam JM. The influence of hemostatic agents on bone healing after sternotomy in a porcine model. The Annals of Thoracic Surgery. 2015 (99):1005–1011.
14. Vogt PR, Berdat PA, Santoro G, Schmidlin D, Khubulava GG, Marchenko S, Andreas M, Laufer G, Tabori E, Darrel A. Significant Reduction of Sternal Wound infection in Cardiac Surgical Patients. American Journal of Clinical Microbiology and Antimicrobials. 2019 2(2):1035
15. Zhou P, Zhu P, Nie Z, Zheng S. Is the era of bilateral internal thoracic artery grafting coming for diabetic patients? An updated meta-analysis. 2019 Dec;158(6):1559-1570. doi: 10.1016/j. jtcvs.2019.01.129.
Review
For citations:
Shevchenko A.A., Kobzev E.E., Topalov K.P., Kashkarov E.A., Rosseikin E.V., Zhila N.G., Karpov I.A. The effectiveness of the introduction of a system for the prevention of sternal complications in cardiac surgery. Yakut Medical Journal. 2024;(1):30-33. https://doi.org/10.25789/YMJ.2024.85.08
Views:
20
Email this article 