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. 2017 Aug;140(2):390-400.
doi: 10.1097/PRS.0000000000003514.

A National Study of the Impact of Delayed Flap Timing for Treatment of Patients with Deep Sternal Wound Infection

Erika D Sears  1   2 , Adeyiza O Momoh  1   2 , Kevin C Chung  1   2 , Yu-Ting Lu  1   2 , Lin Zhong  1   2 , Jennifer F Waljee  1   2
Affiliations

A National Study of the Impact of Delayed Flap Timing for Treatment of Patients with Deep Sternal Wound Infection

Erika D Sears et al. Plast Reconstr Surg. 2017 Aug.

Abstract

Background: This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection.

Methods: The authors analyzed the Truven MarketScan Databases from 2009 to 2013 to identify adult patients who developed deep sternal wound infection after open cardiac surgery and who underwent flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing. Multivariable Poisson regressions were used to investigate the relationship between flap timing and number of procedures, number of hospitalizations, and length of stay outcomes. A multivariable log-linear regression model was created for cost analysis. All analyses were adjusted for patient risk factors and treatment characteristics.

Results: The authors identified 612 patients with deep sternal wound infection who underwent flap closure. The timing of flap closure was delayed more than 7 days after diagnosis in 39 percent of patients. Delayed time to flap closure greater than 3 days after diagnosis of infection was associated with higher mortality odds for delay 4 to 7 days (OR, 2.94) and delay greater than 7 days (OR, 2.75; p < 0.03), greater additional procedures for delay 4 to 7 days (incidence rate ratio, 1.72) and delay greater than 7 days (incidence rate ratio, 1.93; p < 0.001), and up to 43 percent longer hospital length of stay and 37 percent greater costs compared with patients undergoing flap closure 0 to 3 days after diagnosis.

Conclusions: Delay in flap closure was associated with greater mortality and resource use. Prompt involvement of reconstructive surgeons may improve quality and efficiency of deep sternal wound infection care.

Clinical question/level of evidence: Therapeutic, III.

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Conflict of interest statement

Disclosure: None of the authors have any financial interest or conflicts of interest to declare in relation to the content of this article.

Figures

Figure 1
Figure 1
Patient selection of cohort undergoing flap reconstruction after deep sternal wound infection. DSWI, deep sternal wound infection. Cardiac surgery includes coronary artery bypass graft surgery, open valve replacement/repair, and open thoracic aneurysm repair.
Figure 2
Figure 2
Adjusted mean probability of mortality based on flap timing after deep sternal wound infection diagnosis. Black lines represent 95% confidence intervals.
Figure 3
Figure 3
Adjusted mean number of procedures based on flap timing after deep sternal wound infection diagnosis. Black lines represent 95% confidence intervals.
Figure 4
Figure 4
Adjusted total hospital days based on flap timing after deep sternal wound infection diagnosis. Black lines represent 95% confidence intervals.
See this image and copyright information in PMC

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References

    1. Kaye AE, Kaye AJ, Pahk B, et al. Sternal wound reconstruction: management in different cardiac populations. Ann Plast Surg. 2010;64:658–666. - PubMed
    1. Atkins BZ, Onaitis MW, Hutcheson KA, et al. Does method of sternal repair influence long-term outcome of postoperative mediastinitis? Am J Surg. 2011;202:565–567. - PubMed
    1. Floros P, Sawhney R, Vrtik M, et al. Risk factors and management approach for deep sternal wound infection after cardiac surgery at a tertiary medical centre. Heart Lung Circ. 2011;20:712–717. - PubMed
    1. Graf K, Ott E, Vonberg RP, et al. Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg. 2010;37:893–896. - PubMed
    1. Kobayashi T, Mikamo A, Kurazumi H, et al. Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery. J Cardiothorac Surg. 2011;6:56. - PMC - PubMed