Surgical Audit of Sternal Wound Infection Following Cardiac Surgery at Inkosi Albert Luthuli Hospital (IALCH), Durban, South Africa

Abstract

Introduction: Sternal wound infection is a devastating complication following cardiac surgery. It is associated with sternal mal-union, mediastinitis and bacteremia with subsequent infective endocarditis and redo surgery. Although the incidence of sternal wound infections has decreased to 1% - 4% of all cardiac surgery procedures. Sternal wound infection continues to be associated with increased morbidity and mortality, and decrease long term life expectancy. New approaches to open heart surgery, deep and superficial wound infection has a significant impact on patients’ morbidity, length of stay and cost of care. This study was to identify risk factors associated with sternal wound infection and prompt treatments measures to decrease this complication. Methods: Between January 2016- December 2018, thirty-eight (38) adult patient above 14 years who underwent cardiac surgery developed sternal wound infection at IALCH, KwaZulu Natal Province. Retrospectively reviewed and analyzed patient’s records were evaluated for demographics, risk factors, management and the outcome in relation to hospital stay and cost. The following risk factors shows significant P value<0.05. Results: The study revealed that, of the 38 patients, 24 were female (63.2%) and 14 male (36.8%), while 26 patients (68.4%) below 60 years, 12 patients (31.6%) above 60 years. 13 patients (34.2%) developed deep sternal wound infection against 25 (65.8%) who developed superficial wound sternal wound infection. Surgical procedure was for valvular heart disease 24 (63.2%), CABG 13 (34.2%) and 1 (2.6%) concomitant CABG and valve replacement. Prolonged ICU stay 3.08 days SD=1.49 was associated with deep sternal wound infection compared to 1.79 days SD=0.723 for superficial, p=0.0001. Conclusion: This study showed that sternal wound infection increases overall hospital stay and is associated with increased overall treatment cost therefore, it is imperative to address known risk factors by adhering to and implementing preventative programs.