Association between post-sternotomy tracheostomy and deep sternal wound infection

a retrospective analysis

Yi-Chin Tsai*, Kevin Phan, Andrie Stroebel, Livia Williams, Lisa Nicotra, Lesley Drake, Elizabeth Ryan, James McGree, Peter Tesar, Kiran Shekar

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Tracheostomy has traditionally been used as a means of facilitated mechanical ventilation in patients requiring respiratory management following cardiac surgery. However in the clinical setting, the advantages of tracheostomy has been questioned by concerns surrounding evidence of its association with increased risk of deep sternal wound infections (DSWI). The present study sought to evaluate retrospectively our experience with post-sternotomy tracheostomy among cardiac surgery patients and association with DSWI.

Methods: Between July 2003 and June 2013, 11,795 patients underwent open cardiac surgery via sternotomy in our department. Among these, 225 underwent post-sternotomy tracheostomy. Data were obtained by reviewing and analyzing the Cardiac Surgical and Cardiac Intensive Care Unit (ICU) databases for adult cardiac patients.

Results: Out of the 11,795 sternotomy patients analyzed, 225 (1.9%) underwent tracheostomy. The overall mortality rate for post-sternotomy tracheostomy patients was 21.3%. DSWI developed in 23 patients (10.2%) of the tracheostomy group. Seven of these 23 patients had DSWI after insertion of tracheostomy. DSWI was significantly higher in tracheostomy versus no-tracheostomy patients (10.2% vs. 0.48%; P

Conclusions: The present study demonstrated that tracheostomy was an independent risk factor for post-sternotomy DSWI, and that DSWI was a predictor of mortality. For tracheostomy patients, coronary artery bypass grafting (CABG) procedures and longer durations of tracheostomy were strong predictors of DSWI. Across all sternotomy patients, tracheostomy, diabetes, urgency status and blood transfusions were significant risk factors for DSWI. As such, the decision for tracheostomy post- sternotomy should be carefully considered on a case by case basis.

Original languageEnglish
Pages (from-to)3294-3300
Number of pages7
JournalJournal of Thoracic Disease
Volume8
Issue number11
DOIs
Publication statusPublished - Nov 2016

Keywords

  • Sternum
  • wound infection
  • cardiac
  • surgery
  • tracheostomy
  • PERCUTANEOUS DILATATIONAL TRACHEOSTOMY

Cite this

Tsai, Y-C., Phan, K., Stroebel, A., Williams, L., Nicotra, L., Drake, L., ... Shekar, K. (2016). Association between post-sternotomy tracheostomy and deep sternal wound infection: a retrospective analysis. Journal of Thoracic Disease, 8(11), 3294-3300. https://doi.org/10.21037/jtd.2016.11.70