■要对与深部胸骨伤口感染相关的变量进行全面的多变量分析,通过正中胸骨切开术进行心脏直视手术后。
■所有成年患者的回顾性队列研究,在2000年01月01日至2020年31月12日期间在欧登塞大学医院接受心脏直视手术的患者从西丹麦心脏登记处提取。使用最大似然逻辑回归分析数据。
■共有15,424例患者接受了心脏直视手术,其中244例发生了深部胸骨伤口感染,相当于1,58%。经过数据审查,最终分析中包括了11,182个条目,其中189个开发了DSWI,相当于1,69%。多变量分析发现以下变量与深部胸骨伤口感染的发展有关(括号中的优势比和95%的机密性间隔):已知的心律失常(1.70;1.16-2.44),左心室射血分数(1.66;1.02-2.58),身体质量指数25-30(1.66;1.12-2.52),身体质量指数30-35(2.35;1.50-3.71),身体质量指数35-40(3.61;2.01-6.33),身体质量指数40+(3.70;1.03-10.20),年龄60-69(1.64;1.04-2.67),年龄70-79(1.95;1.23-3.19),慢性阻塞性肺疾病(1.77;1.21-2.54),再操作(1.63;1.06-2.45),外科输血(1.09;1.01-1.17),重症监护病房输血(1.03;1.01-1.06),已知外周动脉粥样硬化(1.82;1.25-2.61),当前吸烟(1.69;1.20-2.35),插管持续时间(1.33;1.12-1.57)。
心脏直视手术后胸骨深部伤口感染的风险增加是一个多因素问题,而有些变量是不可改变的,有些则不是。重点应该是在手术前优化患者的状况,例如减肥和吸烟。但也是患者周围的因素,例如防止失血和最小化插管时间。
UNASSIGNED: To conduct a comprehensive multivariate analysis of variables associated with deep sternal wound infection, after open-heart surgery via median sternotomy.
UNASSIGNED: A retrospective cohort of all adult patients, who underwent open-heart surgery at Odense University Hospital between 01-01-2000 and 31-12-2020 was extracted from the West Danish Heart Registry. Data were analyzed using maximum likelihood logistic regression.
UNASSIGNED: A total of 15,424 patients underwent open-heart surgery and 244 developed a deep sternal wound infection, equivalent to 1,58 %. After data review 11,182 entries were included in the final analysis, of which 189 developed DSWI, equivalent to 1,69 %. Multivariate analysis found the following variables to be associated with the development of deep sternal wound infection (odds ratios and 95%confidens intervals in parentheses): Known arrhythmia (1.70; 1.16-2.44), Left Ventricular Ejection Fraction (1.66; 1.02-2.58), Body Mass Index 25-30 (1.66; 1.12-2.52), Body Mass Index 30-35 (2.35; 1.50-3.71), Body Mass Index 35-40 (3.61; 2.01-6.33), Body Mass Index 40+ (3.70; 1.03-10.20), Age 60-69 (1.64; 1.04-2.67), Age 70-79 (1.95; 1.23-3.19), Chronic Obstructive Pulmonary Disease (1.77; 1.21-2.54), Reoperation (1.63; 1.06-2.45), Blood transfusion in surgery (1.09; 1.01-1.17), Blood transfusion in intensive care unit (1.03; 1.01-1.06), Known peripheral atherosclerosis (1.82; 1.25-2.61), Current smoking (1.69; 1.20-2.35), Duration of intubation (1.33; 1.12-1.57).
UNASSIGNED: Increased risk of deep sternal wound infection after open-heart surgery is a multifactorial problem, while some variables are unchangeable others are not. Focus should be on optimizing the condition of the patient prior to surgery e.g. weight loss and smoking. But also factors surrounding the patient e.g. preventing blood loss and minimizing intubation time.