Abstract：
Around 36,000 cardiac operations are undertaken in the United Kingdom annually, with most procedures undertaken via median sternotomy. Wound complications occur in up to 8% of operations, with an associated mortality rate of around 47% in late or undetected cases.
To undertake a systematised literature review to identify pre-operative, peri-operative and post-operative risk factors associated with sternal wound complications.
Healthcare databases were searched for articles written in the English language and published between 2013 and 2021. Inclusion criteria were quantitative studies involving patients undergoing median sternotomy for cardiac surgery; sternal complications and risk factors.
1360 papers were identified, with 25 included in this review. Patient-related factors included: high BMI; diabetes; comorbidities; gender; age; presenting for surgery in a critical state; predictive risk scores; vascular disease; severe anaemia; medication such as steroids or α-blockers; and previous sternotomy. Peri-operative risk increased with specific types and combinations of surgical procedures. Sternal reopening was also associated with increased risk of sternal wound infection. Post-operative risk factors included a complicated recovery; the need for blood transfusions; respiratory complications; renal failure; non-diabetic hyperglycaemia; sternal asymmetry and sepsis.
Pre, peri and post-operative risk factors increase the risk of sternal wound complications in cardiac surgery. Generic risk assessment tools are primarily designed to provide mortality risk scores, with their ability to predict risk of wound infection questionable. Tools that incorporate factors throughout the operative journey are required to identify patients at risk of surgical wound infection.
To undertake a systematised literature review to identify pre-operative, peri-operative and post-operative risk factors associated with sternal wound complications.
Healthcare databases were searched for articles written in the English language and published between 2013 and 2021. Inclusion criteria were quantitative studies involving patients undergoing median sternotomy for cardiac surgery; sternal complications and risk factors.
1360 papers were identified, with 25 included in this review. Patient-related factors included: high BMI; diabetes; comorbidities; gender; age; presenting for surgery in a critical state; predictive risk scores; vascular disease; severe anaemia; medication such as steroids or α-blockers; and previous sternotomy. Peri-operative risk increased with specific types and combinations of surgical procedures. Sternal reopening was also associated with increased risk of sternal wound infection. Post-operative risk factors included a complicated recovery; the need for blood transfusions; respiratory complications; renal failure; non-diabetic hyperglycaemia; sternal asymmetry and sepsis.
Pre, peri and post-operative risk factors increase the risk of sternal wound complications in cardiac surgery. Generic risk assessment tools are primarily designed to provide mortality risk scores, with their ability to predict risk of wound infection questionable. Tools that incorporate factors throughout the operative journey are required to identify patients at risk of surgical wound infection.
摘要：
英国每年进行约36,000例心脏手术，大多数手术是通过正中胸骨切开术进行的。伤口并发症发生在高达8%的手术中，在晚期或未被发现的病例中，相关死亡率约为47％。
进行系统的文献综述，以确定术前，围手术期和术后与胸骨伤口并发症相关的危险因素。
在医疗保健数据库中搜索了2013年至2021年之间用英语撰写的文章。纳入标准是定量研究，涉及接受正中胸骨切开术的心脏手术患者；胸骨并发症和危险因素。
鉴定了1360篇论文，这次审查中包括25个。患者相关因素包括：高BMI；糖尿病；合并症；性别；年龄；在危急状态下进行手术；预测风险评分；血管疾病；严重贫血；类固醇或α受体阻滞剂等药物；以及先前的胸骨切开术。围手术期风险随着特定类型和手术程序的组合而增加。胸骨重新开放也与胸骨伤口感染的风险增加有关。术后危险因素包括复杂的恢复；需要输血；呼吸系统并发症；肾衰竭；非糖尿病性高血糖症；胸骨不对称性和败血症。
Pre,围手术期和术后危险因素会增加心脏手术中胸骨伤口并发症的风险。通用风险评估工具主要用于提供死亡风险评分，他们预测伤口感染风险的能力值得怀疑。需要在整个手术过程中纳入因素的工具来识别有手术伤口感染风险的患者。
进行系统的文献综述，以确定术前，围手术期和术后与胸骨伤口并发症相关的危险因素。
在医疗保健数据库中搜索了2013年至2021年之间用英语撰写的文章。纳入标准是定量研究，涉及接受正中胸骨切开术的心脏手术患者；胸骨并发症和危险因素。
鉴定了1360篇论文，这次审查中包括25个。患者相关因素包括：高BMI；糖尿病；合并症；性别；年龄；在危急状态下进行手术；预测风险评分；血管疾病；严重贫血；类固醇或α受体阻滞剂等药物；以及先前的胸骨切开术。围手术期风险随着特定类型和手术程序的组合而增加。胸骨重新开放也与胸骨伤口感染的风险增加有关。术后危险因素包括复杂的恢复；需要输血；呼吸系统并发症；肾衰竭；非糖尿病性高血糖症；胸骨不对称性和败血症。
Pre,围手术期和术后危险因素会增加心脏手术中胸骨伤口并发症的风险。通用风险评估工具主要用于提供死亡风险评分，他们预测伤口感染风险的能力值得怀疑。需要在整个手术过程中纳入因素的工具来识别有手术伤口感染风险的患者。
