Obesity and Preoperative Anaemia as Independent Risk Factors for Sternal Wound Infection After Coronary Artery Bypass Graft Surgery with Pedicled (Non-Skeletonized) Internal Mammary Arteries: The Role of Thoracic Wall Ischemia?
| العنوان: | Obesity and Preoperative Anaemia as Independent Risk Factors for Sternal Wound Infection After Coronary Artery Bypass Graft Surgery with Pedicled (Non-Skeletonized) Internal Mammary Arteries: The Role of Thoracic Wall Ischemia? |
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| المؤلفون: | Ailsa Robbins, Vito G. Ruggieri, Sylvain Rubin, Aurélie Brunet, Odile Bajolet, Anne Poncet, Annick Lefebvre, Yves Assad Saade, Yohan Nguyen |
| المساهمون: | Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Médecine interne, Maladies Infectieuses et Immunologie Clinique [Reims], Centre Hospitalier Universitaire de Reims (CHU Reims) |
| المصدر: | Vascular Health and Risk Management Vascular Health and Risk Management, Dove Medical Press, 2020, Volume 16, pp.553-559. ⟨10.2147/VHRM.S264415⟩ Vascular Health and Risk Management, Dove Medical Press, 2020, Volume16, pp.553-559. ⟨10.2147/vhrm.s264415⟩ |
| بيانات النشر: | HAL CCSD, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Male, obesity, Time Factors, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Body Mass Index, law.invention, Coronary artery disease, Hemoglobins, 0302 clinical medicine, Risk Factors, law, Pharmacology (medical), Hospital Mortality, 030212 general & internal medicine, Coronary Artery Bypass, ComputingMilieux_MISCELLANEOUS, Original Research, Aged, 80 and over, Univariate analysis, internal mammary arteries, Anemia, Hematology, General Medicine, Middle Aged, Intensive care unit, 3. Good health, Treatment Outcome, medicine.anatomical_structure, Female, Cardiology and Cardiovascular Medicine, preoperative anaemia, Thoracic wall, Artery, medicine.medical_specialty, Risk Assessment, 03 medical and health sciences, coronary artery bypass graft surgery, medicine, Humans, Surgical Wound Infection, Aged, Retrospective Studies, business.industry, Public Health, Environmental and Occupational Health, Retrospective cohort study, Perioperative, Length of Stay, medicine.disease, Sternotomy, Surgery, Vascular Health and Risk Management, Complication, business, Biomarkers |
| الوصف: | Aurélie Brunet,1 Yohan N’Guyen,1,* Annick Lefebvre,2,* Anne Poncet,3 Ailsa Robbins,1 Odile Bajolet,2 Yves Saade,3 Vito Giovanni Ruggieri,3,* Sylvain Rubin3,* 1Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France; 2Operational Hygiene Team, Robert Debré University Hospital, Reims, France; 3Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France*These authors contributed equally to this workCorrespondence: Yohan N’GuyenInternal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Avenue du général Koenig, Reims 51092, FranceTel (+33) 3 26 78 94 22Fax (+33) 3 26 78 40 90Email yohan.nguyen@wanadoo.frPurpose: Obesity remains statistically associated with coronary artery disease, for which coronary artery bypass graft surgery (CABG) remains the standard of care. However, obesity is also associated with sternal wound infection (SWI) which is a severe complication of CABG despite advances in surgery and in infection prevention and control. Strategies to reduce the incidence of SWI are still being investigated, and we therefore conducted a retrospective study to revisit factors other than obesity associated with SWI after CABG.Patients and Methods: Data were extracted from the medical records of 182 patients who underwent elective on-pump CABG using one or both pedicled internal mammary artery grafts in Reims University Hospital between May 2015 and May 2016. All preoperative or perioperative variables with a p value< 0.10 in univariate analysis were entered into a stepwise logistic regression model.Results: Among the 182 patients (145 male (79.6%), median age 68.0 [45.0– 87.0] years), 138 (75.8%) underwent CABG using bilateral internal mammary artery grafts. Median BMI was 27.7 [18.7– 50.5] kg/m2, and there were 51 (28.0%) and 79 (43.4%) patients with obesity and overweight, respectively. Twenty-three out of the 182 patients (12.6%) developed SWI. In-hospital mortality was not statistically different between patients with and without SWI but the median length of stay was (6.0 [2.0– 38.0] versus 5.0[3.0– 21.0] days in the intensive care unit, p=0.03, and 26.0 [9.0– 134.0] versus 9.0 [7.0– 51.0] days in hospital, p< 0.0001). Obesity and preoperative anaemia were independently associated with SWI, as was the number of red blood cell (RBC) units transfused (OR 14.61 [2.64– 80.75], OR 4.64 [1.61– 13.34] and OR 1.27 [1.02– 1.58], respectively).Conclusion: The independent association of SWI with the number of RBC units transfused and the existence of preoperative anaemia and obesity suggests a mechanism of thoracic wall ischemia in SWI after CABG, thus leaving insufficient perfusion of the thoracic wall in patients with obesity. Medical strategies are warranted to try to prevent this costly complication.Keywords: obesity, preoperative anaemia, coronary artery bypass graft surgery, internal mammary arteries |
| وصف الملف: | text/html |
| اللغة: | English |
| تدمد: | 1176-6344 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6d3a4547726b867d15bcdb426826f6bc https://hal.univ-reims.fr/hal-03262014 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....6d3a4547726b867d15bcdb426826f6bc |
| قاعدة البيانات: | OpenAIRE |
PDF full text from Publisher | تدمد: | 11766344 |
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