胸骨正中劈开入路心脏术后并发胸部切口感染危险因素的病例对照研究OACSTPCD

Background Median sternotomy is a conventional approach for cardiac surgery,and patients undergoing this approach may develop sternal wound infection(SWI),which may bring heavy economic pressure and great psychological burden and pain to patients.Objective To explore the independent risk factors for SWI,so as to lower its incidence and take preventive measures.Methods A retrospective analysis was conducted on patients who underwent open heart surgery through the median sternotomy approach at Chinese PLA General Hospital from January 2011 to January 2021.Cases of SWI were screened and a 1:4 propensity matching was performed.Characteristic variables were screened by univariate Cox analysis and LASSO regression.After considering expert opinions,appropriate variables were selected for multivariate Cox regression analysis.Results Of the 5 471 cases,61 cases developed SWI within 180 days after thoracotomy,with a incidence rate of 1.11%,44 of whom were SSWI and 17 were DSWI.In the whole cohort of 305 patients,there were 21 males and 40 females in the case group,with a median age of 61 years,while in the control group,there were 110 males and 134 females,with a median age of 59 years.Multivariate Cox regression analysis showed that body mass index(HR[95%CI]:1.07[1.00-1.14],P=0.047),diabetes(HR[95%CI]:1.87[1.01-3.46],P=0.047),and myocardial infarction(HR[95%CI]:2.25[1.19-4.26],P=0.010)were independently associated with SWI.Conclusion We find that the independent risk factors for SWI are diabetes,increased body mass index,and myocardial infarction.These factors are thought to influence the development of SWI by disrupting wound healing process,impairing tissue repair and skin barrier integrity,and decreasing resistance to bacteria.