Meta-analysis Of Risk Factors For Sternal Wound Infection After Cardiac Surgery

Background: Sternal wound infection(SWI)is a common complication after cardiac surgery,especially when combined with deep mediastinitis,which can cause the mortality,hospitalization time and treatment cost to be greatly increased,which affects the success rate of operation and postoperative recovery.The incidence of SWI infection reported at home and abroad is different,most of which are between 0.8% and10%,the incidence of mediastinitis is 1-2%,and the mortality rate can reach 15%.Therefore,it is necessary to analyze and study the risk factors of thoracic incision infection after cardiac surgery,and carry out targeted intervention so as to effectively reduce the occurrence of chest incision infection,or to deal with it timely and accurately,and reduce its harmfulness.Objective: To evaluate the risk factors of thoracic incision infection after cardiac surgery by using evidence-based medical meta-analysis method,and to provide the basis for the clinical management strategy of patients undergoing cardiac surgery.Methods: the published literatures about risk factors of sternal infection after cardiac surgery were collected by searching Pub Med,EMBASE and Cochrane library databases,and data extraction was carried out.The study analyzed 13 related exposure factors,including preoperative basic characteristics(age,gender,BMI,smoking),preoperative disease status(diabetes,hypertension,chronic obstructive pulmonary disease [COPD],renal failure),intraoperative factors(coronary artery bypass grafting,intraoperative blood transfusion,operation time,emergency operation),and postoperative factors(ventilation Time).The combined effect of each risk factor(Odds Ratio,OR)and 95% confidence interval(CI)were calculated by Using Stata 12.0software.The sensitivity analysis was conducted by single study exclusion method to evaluate the stability of the results.According to the funnel map distribution symmetry and the Begg’s test,the potential publication bias was evaluated.Results: 39 literatures were included in this study,and the design of the study was case-control.The quality score included in the literature was between 4 and 8.The results of meta-analysis showed that obesity(OR:1.99,95% CI:1.60,2.46,P < 0.001),smoking(OR:1.49,95%CI:1.23,1.81,P < 0.001),preoperative diabetes(OR:1.94,95% CI:1.74,2.17,P <0.001),COPD(OR:1.23,95% CI:1.09,1.39,P =0.001),Renal failure(OR:2.00,95%CI:1.36,2.94,P < 0.001),coronary artery bypass grafting(OR:2.20,95% CI:1.73,2.80,P < 0.001),intraoperative blood transfusion(OR:1.38,95% CI:1.13,1.69,P =0.001),emergency operation(OR:1.96,95% CI:1.17,3.28,P =0.010)were significantly related to sternal infection after cardiac surgery.In addition,men(OR:0.56,95% CI: 0.44,0.73,P < 0.001),the age(or:1.02,95% CI:1.00,1.04,P =0.053),hypertension(OR:2.30,95%CI: 0.78,6.77,P =0.131),operation time(OR:1.05,95% CI:0.81,1.36,P =0.704),postoperative mechanical ventilation time(OR:1.01,95% CI:0.96,1.07,P =0.624)were significantly related to sternal infection after cardiac surgery.Conclusion:Meta-analysis showed that obesity,diabetes,COPD,coronary artery bypass grafting,smoking,renal failure,emergency operation,blood transfusion were the risk factors of sternal infection after heart surgery.In clinical,preoperative evaluation should be carried out actively,and patients with the above risk factors should be paid attention to.Early treatment and follow-up should be carried out actively after operation,so as to reduce the incidence of sternal infection and improve the prognosis.