Abstract 18926: Skeletonization Mitigates Risk of Deep Sternal Wound Infection in Patients With Diabetes Undergoing CABG With Bilateral Internal Mammary Arterial Grafting

Abstract

Background Bilateral internal mammary artery (BIMA) grafting may provide benefits compared to single artery coronary artery bypass grafting (CABG). However, many surgeons cite deep sternal wound infections (DSWI) as a deterrent for use of BIMA in patients with diabetes (DM). Aim To evaluate the effect of DM and skeletonization on the incidence of DSWI in patients with BIMA grafting. Hypothesis Skeletonization reduces risk of DSWI in DM patients with BIMA. Methods A retrospective analysis from 11 hospitals in the Maryland Cardiac Surgery Quality Initiative was performed. Of 27,930 adult non-emergent CABGs between 2017 and 2022, 2,010 patients (7%) received BIMA grafting among whom 764 (38%) had DM. Effect of DM and skeletonization of ≥ 1 IMA on DSWI in BIMA patients was evaluated by chi-square analyses and multivariable logistic regressions adjusting for DSWI-specific STS risk score. Results There was no significant difference in preoperative glycosylated hemoglobin (HgbA1c) level for DM patients with and without BIMA (7.2 [6.5-8.4] vs 7.2 [6.5-8.5], P=0.842. BMI was significantly higher in DM vs non-DM patients (30 [27 - 33] vs 28 [25 - 31], respectively, P<0.001]. Skeletonization of ≥ 1 IMA in DM patients reduced DSWI vs. no skeletonization (0.3% vs 4.1%, respectively, P=0.023) but did not alter DSWI in non-DM patients (0.4% vs 1.2%, P=0.280). In patients with skeletonization of ≥1 IMA, there was no difference in DSWI between patients with and without DM (0.3% vs 0.4%, respectively, P>0.999; Figure 1). After adjusting the DSWI-specific STS risk scores, skeletonization remained independently associated with reduced DSWI risk in DM patients with BIMA (OR=0.09, P =0.044). Conclusions Skeletonization of ≥1 IMA was associated with lower risk of DSWI in BIMA patients with DM. This supports the use of BIMA with skeletonization in patients with DM barring other prohibitive risk factors, and may encourage its increased usage in skeptical surgeons.