Zusammenfassung
Die Inzidenz tiefer Sternuminfektionen nach herzchirurgischen Eingriffen wird in der Literatur zwischen 0,25% und 7% angegeben. Diese Komplikation stellt einen schwerwiegenden Faktor für Morbidität und Mortalität im Rahmen herzchirurgischer Eingriffe dar. In der vorliegenden Studie berichten wir über das Ergebnis und die zugrundeliegenden Risikofaktoren von 249 Patienten, die eine, oder auch mehrfache Sternumdehiszenzen mit konsekutiver Reverdrahtung bedingten. Statistische Analysen ergaben, dass Alter, das Vorliegen einer chronisch obstruktiven Lungenerkrankung, Diabetes mellitus und ein erhöhter Body-Mass-Index signifikante Faktoren für die Entwicklung einer Sternumdehiszenz darstellen. Die am häufigsten nachgewiesenen Keime bei Sternuminfektionen waren: Staphylococcus aureus und epididermidis (73%), Enterokokken (8%) und Pseudomonas aeruginosa (7%). Darüber hinaus waren Diabetes mellitus und die Therapie mit Steroiden mit einer erhöhten Inzidenz von mehrfach notwendiger Sternum-Reverdrahtung verbunden. Zusammenfassend werden unterschiedliche präoperative Risikofaktoren für die Entwicklung einer Sternumdehiszenz ermittelt. Bei Patienten mit Diabetes mellitus könnte die kontinuierliche intravenöse Gabe von Insulin dazu betragen, die Inzidenz postoperativer Sternuminfektionen zu reduzieren.
Summary
The incidence of mediastinitis after cardiac operations is reported between 0.25% and 7% and is one of the major causes of postoperative morbidity and mortality. The purpose of this study is to define patient variables that contribute to morbidity and mortality of median sternotomy wound infection and the results of surgical treatment. We report the outcome and preoperative factors of 249 patients over 16 years with sternal wound dehiscence. Statistical analysis revealed age, the presence of chronic obstructive pulmonary disease, diabetes mellitus and body mass index as significant preoperative risk factors. Furthermore, diabetes mellitus and the use of steroids were significant factors for repeated sternal dehiscence. Staphylococcus aureus und epididermidis (73%), Enterococcus (8%) and Pseudomonas aeroginosa (7%) were responsible for deep sternal wound infection. In conclusion, the observed independent risk factors related to the patient’s antecendents and also risk factors for repeated sternum dehiscence. The use of continuous intra- venous insulin infusion in patients with diabetes mellitus could be helpful to diminish the incidence of deep sternal wound infection.
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Kuroczynski, W., Peivandi, A., Pruefer, D. et al. Präoperative Risikofaktoren und sternale Wundheilungsstörungen nach Herzoperationen mit Sternotomie im Erwachsenenalter. Z Herz- Thorax- Gefäßchir 19, 32–36 (2005). https://doi.org/10.1007/s00398-005-0472-6
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DOI: https://doi.org/10.1007/s00398-005-0472-6