Efficacy of new multimodal preventive measures for post-operative deep sternal wound infection

Background: Deep sternal wound infection (DSWI) is a critical complication of cardiovascular surgery. This study aimed to confirm the efficacy of new, multimodal preventive measures for post-operative DSWI. Methods: From January 2008 to December 2012, 1240 patients underwent cardiovascular surgery via median sternotomy at our hospital. The patients were divided into two groups according to the period in which surgery was performed: those treated before and those treated after January 2011, which was when we implemented the new preventive measures against DSWI. The preventive measures included routine use of an off-pump technique in coronary artery bypass grafting, higher body temperature of pump cases, screening and pre-operative eradication of nasal methicillin-resistant Staphylococcus aureus colonization, and use of a microbial sealant. We compared the incidence of DSWI between the two time periods. Univariate and multivariate analyses were also performed for the entire period to identify DSWI risk factors. Results: Only 1 case (0.2%) of DSWI was noted among 554 patients in the latter period while 25 patients (3.6%) experienced DSWI among the 686 patients in the earlier period (p < 0.0001). The risk factors for DSWI were body mass index (BMI) ≥ 25 kg/m² and operation time ≥ 8 h. Conclusions: We observed a marked decrease in the incidence of DSWI after the implementation of multimodal preventive measures. The risk factors for DSWI were BMI ≥ 25 kg/m² and operation time ≥ 8 h.