Our Summary

This research paper is about the risks linked to chest wound complications after heart surgery. Each year, around 36,000 heart surgeries are performed in the UK. However, around 8% of these surgeries result in wound complications, which can lead to death in around 47% of cases if not detected early.

The researchers reviewed scientific papers published between 2013 and 2021 to identify risk factors before, during, and after surgery that could lead to chest wound complications. They found 1,360 relevant papers, and included 25 in their review.

Some of the risk factors they found were related to the patient’s health. For example, patients who were obese, had diabetes, other health conditions, or who were in a critical condition before surgery were more likely to have wound complications. Other risk factors included the patient’s age, gender, and whether they had undergone this type of surgery before.

There were also risks associated with the surgery itself. Some types of heart surgery or combinations of procedures were riskier than others. Additionally, patients who needed their chest reopened were more likely to get a wound infection.

After surgery, patients with a complicated recovery, those who needed blood transfusions, had breathing problems, kidney failure, high blood sugar (even if they weren’t diabetic), uneven chest bones, or sepsis (a severe infection) were also more likely to have wound complications.

The researchers concluded that many factors can increase the risk of chest wound complications after heart surgery. Current tools to predict this risk are mostly designed to predict the risk of death, not wound infection. They suggest that new tools are needed that consider all these risk factors to better identify patients who are at risk of wound infection after heart surgery.

FAQs

  1. What are the common risk factors associated with sternal wound complications in cardiac surgery?
  2. How does the type and combination of surgical procedures affect the risk of sternal wound complications?
  3. How reliable are the current risk assessment tools in predicting the risk of wound infection in cardiac surgeries?

Doctor’s Tip

A doctor might tell a patient undergoing sternotomy for cardiac surgery to maintain good hygiene practices, such as keeping the incision site clean and dry, to reduce the risk of sternal wound complications. They may also advise the patient to follow their post-operative care instructions carefully, including avoiding strenuous activities that could put strain on the incision site. It is important for the patient to report any signs of infection, such as redness, swelling, or discharge, to their healthcare provider promptly.

Suitable For

Patients who are typically recommended sternotomy for cardiac surgery are those with high BMI, diabetes, comorbidities, gender, age, presenting for surgery in a critical state, predictive risk scores, vascular disease, severe anaemia, medication such as steroids or α-blockers, and previous sternotomy. Peri-operative risk factors include specific types and combinations of surgical procedures, as well as sternal reopening. Post-operative risk factors include a complicated recovery, the need for blood transfusions, respiratory complications, renal failure, non-diabetic hyperglycaemia, sternal asymmetry, and sepsis. It is important to assess and address these risk factors to reduce the likelihood of sternal wound complications in cardiac surgery patients.

Timeline

Before sternotomy:

  • Patient may have pre-existing risk factors such as high BMI, diabetes, comorbidities, and vascular disease
  • Patient may be taking medications such as steroids or α-blockers
  • Patient may have undergone previous sternotomy
  • Patient may have presented for surgery in a critical state
  • Risk factors may be assessed using predictive risk scores

After sternotomy:

  • Peri-operative risk factors may include specific types and combinations of surgical procedures
  • Sternal reopening increases the risk of sternal wound infection
  • Post-operative risk factors may include complications during recovery, need for blood transfusions, respiratory complications, renal failure, non-diabetic hyperglycaemia, sternal asymmetry, and sepsis

Overall, pre, peri, and post-operative risk factors can increase the risk of sternal wound complications in cardiac surgery. Generic risk assessment tools may not be sufficient to predict the risk of wound infection, and tools that incorporate factors throughout the operative journey are needed for better risk identification.

What to Ask Your Doctor

  1. What specific pre-operative factors increase my risk of developing sternal wound complications?
  2. Are there any steps I can take before surgery to reduce my risk of sternal wound infections?
  3. What specific peri-operative factors should I be aware of that may increase my risk of sternal wound complications during surgery?
  4. Are there any specific surgical procedures or combinations of procedures that may increase my risk of sternal wound complications?
  5. What post-operative factors should I watch out for that may indicate a higher risk of sternal wound infections during my recovery?
  6. Are there any specific steps I can take during my recovery to reduce my risk of developing sternal wound complications?
  7. How will my medical history, including factors like my BMI, diabetes, and previous surgeries, impact my risk of sternal wound complications?
  8. Are there any medications I am currently taking that may increase my risk of sternal wound infections during surgery?
  9. What are the signs and symptoms of sternal wound infections that I should watch out for after surgery?
  10. What steps will be taken during and after my surgery to minimize my risk of developing sternal wound complications?

Reference

Authors: Morrell Scott N, Lotto RR, Spencer E, Grant MJ, Penson P, Jones ID. Journal: Heart Lung. 2022 Sep-Oct;55:89-101. doi: 10.1016/j.hrtlng.2022.04.013. Epub 2022 Apr 30. PMID: 35504241