{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T11:18:33Z","timestamp":1773314313579,"version":"3.50.1"},"reference-count":23,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2003,6,1]],"date-time":"2003-06-01T00:00:00Z","timestamp":1054425600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovascular Surgery"],"published-print":{"date-parts":[[2003,6]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk for deep sternal wound infections and\/or sternal dehiscence. In contrast to previous studies that examined risk factors for sternal infections this study evaluates factors that lead to poor outcome after surgical revision of the non healing sternum. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> Between 1985 and 1999, 193 adults (mean age 64 \u00b1 9 years, m\/f = 3\/1) necessitated sternal revisions (incidence 1.93%). Pre-, intra- and post-operative risk factors were evaluated for their influence on the outcome after sternal revision. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> 65 of the 193 patients had a complicated course: ten (5.2%) died due to sepsis\/multi organ failure ( n = 6) or cardiac causes ( n = 4). 32 patients (16.6%) needed several revisions, 17 (9%) were discharged with sternal instability, 5 (3%) with chronic fistula and one with persistent osteomyelitis. Univariate and multivariate analysis identified cardiopulmonary resuscitation (odds ratio ( OR) = 11.188, p = 0.010), corticoid treatment ( OR = 7.043, p = 0.0055), diabetes ( OR = 4.130, p = 0.0128), smoking history ( OR = 2.996, p = 0.0041), renal insufficiency (hazard ratio ( HR) = 1.884), old age ( OR = 1.108, p = 0.0266), high body mass ( HR = 1.06), ECC time ( p = 0.023), cross clamp time ( p = 0.028), systemic hypothermia ( p = 0.016), non-use of IMA ( p = 0.042) or prolonged ventilation as risk factors for mortality or poor outcome. No correlation between sternal closure technique, mediastinal irrigation or antibiotic therapy and outcome after mediastinal revision could be found. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> To avoid disappointing results after sternal revision one should aim to preoperatively identify high-risk patients and aggressively address risk factors. This rather than modifications of the surgical and medical approach might improve the outcome of patients with mediastinal complications. <\/jats:p><\/jats:sec>","DOI":"10.1177\/096721090301100306","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T13:10:10Z","timestamp":1663074610000},"page":"207-212","source":"Crossref","is-referenced-by-count":10,"title":["Risk Factors Influencing the Outcome after Surgical Treatment of Complicated Deep Sternal Wound Complications"],"prefix":"10.1177","volume":"11","author":[{"given":"A. A.","family":"Peivandi","sequence":"first","affiliation":[{"name":"Departments for Cardiothoracic- and Vascular Surgery, Johannes Gutenberg- University Hospital, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Kasper-K\u00f6nig","sequence":"additional","affiliation":[{"name":"Departments for Cardiothoracic- and Vascular Surgery, Johannes Gutenberg- University Hospital, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Quinkenstein","sequence":"additional","affiliation":[{"name":"Departments for Cardiothoracic- and Vascular Surgery, Johannes Gutenberg- University Hospital, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. H.","family":"Loos","sequence":"additional","affiliation":[{"name":"Institute of Medical Statistics, Johannes Gutenberg- University Hospital, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Dahm","sequence":"additional","affiliation":[{"name":"Departments for Cardiothoracic- and Vascular Surgery, Johannes Gutenberg- University Hospital, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2003,6,1]]},"reference":[{"key":"bibr1-096721090301100306","first-page":"443","volume":"12","author":"Antunes P. E.","year":"1997","journal-title":"Mediastinitis after aorto-coronary bypass surgery"},{"key":"bibr2-096721090301100306","first-page":"753","volume":"42","author":"Julian O. C.","year":"1957","journal-title":"The median sternal incision in intracardiac surgery with extracorporal circulation: A general evaluation of its use in heart surgery"},{"key":"bibr3-096721090301100306","unstructured":"Bojar R. M. Wound care and infectious complications. Manual of perioperative care in cardiac surgery, Third edition, Blackwell Science, Malden USA, 1999 395\u2013398."},{"key":"bibr4-096721090301100306","first-page":"1050","volume":"65","author":"Borger M. A.","year":"1998","journal-title":"Deep sternal wound infection: Risk factors and outcomes"},{"key":"bibr5-096721090301100306","first-page":"412","volume":"37","author":"Breyer R.","year":"1984","journal-title":"A prospective study of sternal wound complications"},{"key":"bibr6-096721090301100306","first-page":"458","volume":"49","author":"Demmy T. L.","year":"1990","journal-title":"Recent experience with major sternal wound complications"},{"key":"bibr7-096721090301100306","first-page":"967","volume":"156","author":"Nagachinta T.","year":"1987","journal-title":"Risk factors for surgical wound infections following cardiac surgery"},{"key":"bibr8-096721090301100306","first-page":"153","volume":"9","author":"Blanchard A.","year":"1995","journal-title":"Incidence of deep and superficial sternal infection after open heart surgery. A ten years retrospective study from 1981 to 1991"},{"key":"bibr9-096721090301100306","first-page":"766","volume":"225","author":"Jones G.","year":"1997","journal-title":"Management of the infected median sternotomy wound with muscle flaps"},{"key":"bibr10-096721090301100306","first-page":"216","volume":"171","author":"Kluytmans J. A.","year":"1995","journal-title":"Nasal carriage of staphylococcus aureus as a major risk factor for wound infections after cardiac surgery"},{"key":"bibr11-096721090301100306","first-page":"714","volume":"72","author":"Culliford A. T.","year":"1976","journal-title":"Sternal and costochondral infections following open\u2014heart surgery. A review of 2,594 cases"},{"key":"bibr12-096721090301100306","first-page":"179","volume":"49","author":"Loop F. D.","year":"1990","journal-title":"Sternal wound complications after isolated coronary artery bypass grafting: Early and late mortality, morbidity, and cost of care"},{"key":"bibr13-096721090301100306","first-page":"850","volume":"95","author":"Crosgrove D. M.","year":"1988","journal-title":"Does bilateral internal mammary artery grafting increase surgical risk?"},{"key":"bibr14-096721090301100306","first-page":"899","volume":"104","author":"Seyfer A. E.","year":"1988","journal-title":"Sternal blood flow after median sternotomy and mobilisation of the internal mammary arteries"},{"key":"bibr15-096721090301100306","first-page":"1046","volume":"65","author":"Rand R. P.","year":"1998","journal-title":"Prospective trial of catheter irrigation and muscle flaps for sternal wound infection"},{"key":"bibr16-096721090301100306","first-page":"1146","volume":"11","author":"Stahle E.","year":"1997","journal-title":"Sternal wound complications\u2014incidence, microbiology and risk factors"},{"key":"bibr17-096721090301100306","first-page":"419","volume":"63","author":"Sanfelippo P. M.","year":"1972","journal-title":"Complications associated with median sternotomy"},{"key":"bibr18-096721090301100306","first-page":"272","volume":"20","author":"Fari\u00f1as M. C.","year":"1995","journal-title":"Suppurative mediastinitis after open-heart surgery: A case\u2014control study covering a seven-year period in Santander, Spain"},{"key":"bibr19-096721090301100306","first-page":"356","volume":"63","author":"Zerr K. J.","year":"1997","journal-title":"Glucose control lowers the risk of wound infection in diabetics after open heart operations"},{"key":"bibr20-096721090301100306","first-page":"466","volume":"39","author":"Masuda M.","year":"1990","journal-title":"Decreased fluidity of polymorphonuclear leucocyte membrane in streptozocin\u2014induced diabetes rats"},{"key":"bibr21-096721090301100306","first-page":"544","volume":"37","author":"Sima A. A.","year":"1988","journal-title":"acterial phagocytosis and intracellular killing by alveolar macrophages in BB rats"},{"key":"bibr22-096721090301100306","first-page":"60","volume":"15","author":"Hennessy P. 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