High-quality cardiac surgery through teamwork

The high-quality cardiothoracic surgery program is primed for mindful effective surgery. The challenge lies in attaining mindful skills and efficiency. Herein is one journey toward high departmental quality over two decades.

Risk factors for sternal wound infection in men versus women

BACKGROUND: Differences between men and women in complication rates after cardiac surgery have been reported. The rate of one of the most severe postoperative complications, sternal wound infection, has not been compared between the sexes. OBJECTIVE: To compare the frequencies of 21 risk factors for sternal wound infection between men and women. METHODS: Records of 306 patients who had cardiac surgery between 1989 and 1999 at 3 different hospitals in the southwestern and southeastern United States were reviewed for 21 risk factors. Of the 306 patients, 115 (25 women and 90 men) had experienced a sternal wound infection and 191 randomly selected patients (52 women and 139 men) had not. RESULTS: Three risk factors occurred at significantly different rates in men and women. Smoking and use of a single internal mammary artery for grafting were more common in men than women. Women were older than men at the time of cardiac surgery. Logistic regression analyses showed that the 3 dichotomous risk factors (use of single internal mammary artery for grafting, smoking, age > 70 years) that univariate analysis indicated were significantly related to sex could also be used to predict infection group. CONCLUSIONS: This study contributes to the awareness of the possible differences between men and women in the risk of sternal wound infection developing after cardiac surgery. Although 3 risk factors occurred at significantly different rates in men and women, further research is needed to determine the effects that these differences in risk factors may have on the occurrence of sternal wound infection in men and women.

Risk factors for sternal wound infection in men versus women

BACKGROUND

Differences between men and women in complication rates after cardiac surgery have been reported. The rate of one of the most severe postoperative complications, sternal wound infection, has not been compared between the sexes.

OBJECTIVE

To compare the frequencies of 21 risk factors for sternal wound infection between men and women.

METHODS

Records of 306 patients who had cardiac surgery between 1989 and 1999 at 3 different hospitals in the southwestern and southeastern United States were reviewed for 21 risk factors. Of the 306 patients, 115 (25 women and 90 men) had experienced a sternal wound infection and 191 randomly selected patients (52 women and 139 men) had not.

RESULTS

Three risk factors occurred at significantly different rates in men and women. Smoking and use of a single internal mammary artery for grafting were more common in men than women. Women were older than men at the time of cardiac surgery. Logistic regression analyses showed that the 3 dichotomous risk factors (use of single internal mammary artery for grafting, smoking, age > 70 years) that univariate analysis indicated were significantly related to sex could also be used to predict infection group.

CONCLUSIONS

This study contributes to the awareness of the possible differences between men and women in the risk of sternal wound infection developing after cardiac surgery. Although 3 risk factors occurred at significantly different rates in men and women, further research is needed to determine the effects that these differences in risk factors may have on the occurrence of sternal wound infection in men and women.

Transmyocardial laser revascularization

Transmyocardial laser revascularization (TMR) is a procedure that is in a state of transition. The purpose of this article is to review the historical aspects of TMR. Important nursing aspects of the thoracotomy and percutaneous approaches are detailed. Outcomes related to the surgical procedure are also discussed. Although the exact mechanism of TMR is unknown, the procedure offers an improvement in the quality of life, reduction in antianginal medications, increased exercise tolerance, and a possibility of prolonged life.

Development of the Sternal Wound Infection Prediction Scale

OBJECTIVE

To develop an instrument to reliably predict the occurrence of sternal wound infection (SWI).

DESIGN

Instrument development with retrospective chart review.

SETTING

Southwestern university-affiliated medical center.

PATIENTS

One hundred eighty-five adults who underwent cardiac surgery. SWI developed in 94 patients, and 91 remained infection free. In phase 1, there were 82 subjects: SWI developed in 41, and 41 remained infection free. In phase 2, there were 103 subjects: SWI developed in 53, and 50 remained infection free.

OUTCOME MEASURE

Development of a postoperative SWI.

INTERVENTION

The Sternal Wound Infection Prediction Scale (SWIPS) was developed in 2 phases. Phase 1 consisted of designing the SWIPS with use of 19 risk factors most often identified with SWI and revising this scale (SWIPS-R) with use of 21 risk factors. Eighty-two patient records were reviewed. After determining the mean cutscores in phase 1, phase 2 provided cross-validation results with use of 103 additional patient records.

RESULTS

The SWIPS produced 62.1% correct predictions of infection and noninfection; whereas the SWIPS-R produced 72.8% correct predictions. Phase 2 cross-validation results for the 21 risk factors demonstrated that 62.1% and 72.8% of the patients were correctly diagnosed using the SWIPS and SWIPS-R, respectively. A multivariate logistic regression was also performed on the risk factors to predict infection/noninfection groups for all 185 patients. A reduced logistic regression model included 9 of the risk factors and correctly classified 76.2% of the subjects.

CONCLUSIONS

The SWIPS-R, with 21 risk factors, and the logistic regression model, with 12 risk factors, provided excellent classification rates of infection/noninfection. However, more data need to be collected to further strengthen reliability.

Sternal wound infection: a case study of a devastating postoperative complication

Patients with a sternal wound infection are often admitted to the ICU or to a telemetry unit. The case of MW is extreme; most patients with a sternal wound infection can be successfully treated with antibiotic therapy and debridement. However, this case illustrates what devastating effects a sternal wound infection can have and the importance of nursing care and prevention. Nurses have a key role in minimizing the severity of sternal wound infection by being aware of the risk factors and providing thorough discharge teaching to patients so that signs and symptoms are reported early.

Sternal wound infection: a case study of a devastating postoperative complication

Patients with a sternal wound infection are often admitted to the ICU or to a telemetry unit. The case of MW is extreme; most patients with a sternal wound infection can be successfully treated with antibiotic therapy and debridement. However, this case illustrates what devastating effects a sternal wound infection can have and the importance of nursing care and prevention. Nurses have a key role in minimizing the severity of sternal wound infection by being aware of the risk factors and providing thorough discharge teaching to patients so that signs and symptoms are reported early.