A multimodal approach for reducing wound infections after sternotomy*1

Abstract

As previous efforts failed to reduce infection rates after cardiac surgery at our institution, we developed a concept based on adjustment of surgical technique. This concept was then evaluated in clinical practice. We modified our surgical technique towards: minimizing contamination, avoidance of devitalizing tissue, and securing a rigid fixation of the caudal part of sternum. After a pilot series sequential series was compared before and after introduction of the modified technique in a case-series design. All surgical site infections were recorded at discharge, after 6 weeks and by the attending cardiologist at 2 and 6 months. In the pilot series 9/136 patients developed sternal wound infections (SWI) compared with 15/89 patients in the control group (P=0.015). In the larger study population we found a significant drop in the total number of SWIs (72/772 vs 124/772, P<0.0001). Although not statistically significant a 32% reduction in deep SWIs was observed. No reduction in infections at harvest sites for graft material was seen. The preliminary results from the pilot study appear reproducible and we were able to reduce the incidence of SWIs significantly, using this simple modified surgical technique.