The impact of deep sternal wound infections treated by negative pressure on early, 1 year and late mortality: A longitudinal case-control study.

Abstract

Deep sternal wound infection (DSWI) after cardiac surgery, is a rare complication that can be fatal. Due to a lack of available data, we compared early in-hospital, 1-year and long-term mortality in patients with DSWI. Patients undergoing any type of cardiac surgery, in the Cardiothoracic Surgery Department of G. Papanikolaou Hospital, between May 2012 and December 2016, were investigated. All patients who developed DWSI postoperatively, treated with negative pressure wound therapy (NPWT), were included in the group of cases. A random population from the rest of the patients was selected in a 1:2 ratio, representing controls. From a total of 2104 patients, 80 patients (3.8%) developed DSWI (cases group), whereas 180 patients were randomly selected as controls. Early (within 30 days) mortality was significantly higher in the DSWI group compared with controls (15% vs 3.9%, respectively; P = .002). Similarly, more deaths occurred in the cases group compared with controls during the follow-up (ie, 19 vs 12, respectively; P < .001); the majority of deaths (84.2%) occurred within the first year. Long-term survival did not differ between the two study groups during follow-up (median duration = 1072 vs 1022 days for cases and controls, respectively). DSWI significantly increased early and 1-year mortality in poststernotomy patients treated with NPWT compared with those not developing this complication. However, long-term survival was similar between the two study groups, thus highlighting the beneficial effect of NPWT in terms of clinical outcomes in patients with DWSI.