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

Steingrímsson, Steinn ; Gustafsson, Ronny LU ; Gudbjartsson, Tomas ; Mokhtari, Arash LU ; Ingemansson, Richard LU and Sjögren, Johan LU (2009) In Annals of Thoracic Surgery 88(6). p.1910-1915
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: The cumulative incidence of SCF at one year was 0.23%. There was no significant difference in mean time from sternal closure after cardiac... (More)
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Sternocutaneous fistula is a devastating diagnosis with significant morbidity and mortality. Previous SWI, renal failure, smoking, and use of bone wax are major risk factors. However, in a majority of patients SCF is not preceded by SWI and our results indicate that SCF may be a foreign body infection that develops in susceptible patients with risk factors for poor wound healing. Negative-pressure wound therapy may be a valuable adjunct in the treatment of extensive SCF. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Thoracic Surgery
volume
88
issue
6
pages
1910 - 1915
publisher
Elsevier
external identifiers
  • wos:000272029100028
  • pmid:19932261
  • scopus:71649095996
  • pmid:19932261
ISSN
1552-6259
DOI
10.1016/j.athoracsur.2009.07.012
language
English
LU publication?
yes
id
f0bea708-f1fa-40b0-ae82-684dfb0fa4b2 (old id 1511639)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19932261?dopt=Abstract
date added to LUP
2016-04-04 08:54:27
date last changed
2022-03-23 03:14:32
@article{f0bea708-f1fa-40b0-ae82-684dfb0fa4b2,
  abstract     = {{BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Sternocutaneous fistula is a devastating diagnosis with significant morbidity and mortality. Previous SWI, renal failure, smoking, and use of bone wax are major risk factors. However, in a majority of patients SCF is not preceded by SWI and our results indicate that SCF may be a foreign body infection that develops in susceptible patients with risk factors for poor wound healing. Negative-pressure wound therapy may be a valuable adjunct in the treatment of extensive SCF.}},
  author       = {{Steingrímsson, Steinn and Gustafsson, Ronny and Gudbjartsson, Tomas and Mokhtari, Arash and Ingemansson, Richard and Sjögren, Johan}},
  issn         = {{1552-6259}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1910--1915}},
  publisher    = {{Elsevier}},
  series       = {{Annals of Thoracic Surgery}},
  title        = {{Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up.}},
  url          = {{http://dx.doi.org/10.1016/j.athoracsur.2009.07.012}},
  doi          = {{10.1016/j.athoracsur.2009.07.012}},
  volume       = {{88}},
  year         = {{2009}},
}