Comparison of Outcome of Median Sternotomy Lavage in Diabetic and Non-Diabetic Patients of Coronary Artery Bypass Graft Surgery in Terms of Wound Infection, Wound Dehiscence, and Hospital Stay
DOI:
https://doi.org/10.54112/bcsrj.v6i11.2176Keywords:
Coronary Artery Bypass, Surgical Wound Infection, Diabetes Mellitus, Sternotomy, Postoperative ComplicationsAbstract
Sternal wound complications after coronary artery bypass grafting (CABG) are a significant source of postoperative morbidity, especially in diabetic patients who experience impaired healing and higher infection risk. Current evidence on early postoperative wound outcomes in diabetic versus non-diabetic CABG patients in Pakistan is limited. Objective: To compare the frequency of early postoperative sternal wound infection, wound dehiscence, and length of hospital stay between diabetic and non-diabetic patients undergoing CABG via median sternotomy with saline lavage at a tertiary cardiac care center in Pakistan. Methods: This descriptive study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, over three months from 4 May to 4 August 2025. Ninety adult patients undergoing elective CABG via median sternotomy with standardized saline lavage were enrolled. Patients were stratified into diabetic (HbA1c ≥ 6.4%) and non-diabetic (HbA1c < 6.4%) groups. Wound infection was assessed clinically on postoperative day five, and wound dehiscence on postoperative day seven. Length of postoperative hospital stay was recorded. Continuous variables were summarized as mean ± standard deviation, and categorical variables were summarized as frequencies and percentages. Group comparisons were performed using chi-square and appropriate parametric tests, with p ≤ 0.05 considered statistically significant. Results: The cohort's mean age was 56.8 ± 9.0 years, with a male predominance (75.6%). Thirty-six patients (40.0%) were diabetic. Postoperative wound infection occurred in 15.6% of patients, with a significantly higher frequency in diabetics compared with non-diabetics (27.8% vs. 7.4%, p = 0.008). Wound dehiscence was observed in 13.3% of patients, with a higher proportion in diabetics than non-diabetics (19.4% vs. 9.3%), although this difference did not reach statistical significance (p = 0.18). The mean postoperative hospital stay was significantly longer in diabetic patients compared with non-diabetic patients (8.0 ± 2.3 vs. 5.8 ± 1.6 days, p < 0.001). Conclusion: Despite standardized median sternotomy saline lavage, diabetic patients undergoing CABG experienced significantly higher rates of early postoperative wound infection and longer hospital stays compared with non-diabetic patients. These findings highlight the need for intensified perioperative risk stratification and targeted wound care strategies in diabetic CABG patients in resource-limited settings.
Downloads
References
Mirhosseini S.. Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40). International Journal of Clinical and Experimental Medical Sciences 2015;1(3):38. https://doi.org/10.11648/j.ijcems.20150103.12
Dohmen P., Markou T., Ingemansson R., Rotering H., Hartman J., Valen R., et al. Use of Incisional Negative Pressure Wound Therapy on Closed Median Sternal Incisions after Cardiothoracic Surgery: Clinical Evidence and Consensus Recommendations. Medical Science Monitor 2014;20:1814-1825. https://doi.org/10.12659/msm.891169
Bhattacharya S., Sau I., Mohan M., Hazari K., Basu R., & Kaul A Sternal Bands for Closure of Midline Sternotomy Leads to Better Wound Healing. Asian Cardiovascular and Thoracic Annals 2007;15(1):59-63. https://doi.org/10.1177/021849230701500113
Nikulainen V., Helmiö P., Hurme S., &Hakovirta H Vein Harvest Wound Healing after Bypass Surgery for Critical Limb Ischemia. Annals of Vascular Surgery 2020;62:375-381. https://doi.org/10.1016/j.avsg.2019.06.007
Ramzisham A., Raflis A., Khairul‐Asri M., Min J., Fikri A., &Zamrin M Figure-of-Eight vs. Interrupted Sternal Wire Closure of Median Sternotomy. Asian Cardiovascular and Thoracic Annals 2009;17(6):587-591. https://doi.org/10.1177/0218492309348948
Brega C., Calvi S., & Albertini A. Use of a negative pressure wound therapy system over closed incisions option in preventing post‐sternotomy wound complications. Wound Repair and Regeneration 2021;29(5):848-852. https://doi.org/10.1111/wrr.12914
Scott N., Lotto R., Spencer E., Grant M., Penson P., & Jones I. Risk factors for post-sternotomy wound complications across the patient journey: A systematised review of the literature. Heart & Lung 2022;55:89-101. https://doi.org/10.1016/j.hrtlng.2022.04.013
East S., Lorenz R., & Armbrecht E. A. Retrospective Review of Leg Wound Complications After Coronary Artery Bypass Surgery. Aorn Journal 2013;98(4):401-412. https://doi.org/10.1016/j.aorn.2013.07.016
Kumar U., Aslam U., Phillips T., Khalpey Z., &Khalpey Z. Enhancing recovery and outcomes of sternal closure in cardiac surgery: Early results of a 400-patient comparison of suture tapes and steel wires. JTCVS Techniques 2025;31:97-104. https://doi.org/10.1016/j.xjtc.2025.03.016
Kara K.. Bilateral Semi-Skeletonized IMA; Less Thermal Injury, Easier to Harvest, Early Post Operative Comparison with Single IMA Patients After CABG. American Journal of Clinical and Experimental Medicine 2018;6(5):107. https://doi.org/10.11648/j.ajcem.20180605.11
Sofer D., Gurevitch J., Shapira I., Paz Y., Matsa M., Kramer A.et al.. Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting Using Bilateral Skeletonized Internal Mammary Arteries. Annals of Surgery Open 1999;229(4):585-590. https://doi.org/10.1097/00000658-199904000-00020
Bundele V., Aggarwal N., & Bana A Large Sternoabdominal Wound Dehiscence after Cardiac Surgery: Challenging Multimodal Treatment. Advances in Skin & Wound Care 2023;36(5):1-5. https://doi.org/10.1097/01.asw.0000923312.33600.8e
Arazi M., Grosman‐Rimon L., Yehezkeel S., Rimon J., Gohari J., Gleitman S., et al. Predictors of prolonged hospitalization in modified sternoplasty following postoperative mediastinitis. Journal of Cardiac Surgery 2022;37(12):4726-4731. https://doi.org/10.1111/jocs.17099
Scott N., Lotto R., Spencer E., Grant M., Penson P., & Jones I. Risk factors for post-sternotomy wound complications across the patient journey: A systematised review of the literature. Heart & Lung 2022;55:89-101. https://doi.org/10.1016/j.hrtlng.2022.04.013
Lima A., Fernandes G., Araújo R., Gonzaga I., Oliveira R., & Nicolau R Photobiomodulation (Laser and LED) on Sternotomy Healing in Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with Follow-Up. Photomedicine and Laser Surgery 2017;35(1):24-31. https://doi.org/10.1089/pho.2016.4143
Kumar U., Aslam U., Phillips T., Khalpey Z., &Khalpey Z. Enhancing recovery and outcomes of sternal closure in cardiac surgery: Early results of a 400-patient comparison of suture tapes and steel wires. JTCVS Techniques 2025;31:97-104. https://doi.org/10.1016/j.xjtc.2025.03.016
Lazar H., Salm T., Engelman R., Orgill D., & Gordon S. Prevention and management of sternal wound infections. Journal of Thoracic and Cardiovascular Surgery 2016;152(4):962-972. https://doi.org/10.1016/j.jtcvs.2016.01.060
Willy C., Engelhardt M., Stichling M., & Grauhan O.. The impact of surgical site occurrences and the role of closed incision negative pressure therapy. International Wound Journal 2016;13(S3):35-46. https://doi.org/10.1111/iwj.12659
Birgand G., Radu C., Alkhoder S., Attar N., Raffoul R., Dilly M.et al.. Does a gentamicin-impregnated collagen sponge reduce sternal wound infections in high-risk cardiac surgery patients?. Interactive Cardiovascular and Thoracic Surgery 2012;16(2):134-141. https://doi.org/10.1093/icvts/ivs449
Caldonazo T., Dell’Aquila M., Cancelli G., Harik L., Soletti G., Fischer J.et al. Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis. Interdisciplinary Cardiovascular and Thoracic Surgery 2024;38(4). https://doi.org/10.1093/icvts/ivae055
Silverborn M., Heitmann L., Sveinsdóttir N., Rögnvaldsson S., Kristjansson T., &Guðbjartsson T Non-infectious sternal dehiscence after coronary artery bypass surgery. Journal of Cardiothoracic Surgery 2022;17(1). https://doi.org/10.1186/s13019-022-02015-1
Brega C., Calvi S., & Albertini A. Use of a negative pressure wound therapy system over closed incisions option in preventing post‐sternotomy wound complications. Wound Repair and Regeneration 2021;29(5):848-852. https://doi.org/10.1111/wrr.12914
Farzan J.. A Retrospective Application of Deep Sternal Wound Dehiscence and Malunion Risk Scores on Sternal Nonunion Patients. Plastic & Reconstructive Surgery Global Open 2025;13(11):e7281. https://doi.org/10.1097/gox.0000000000007281
Madjarov J., Katz M., Fazal S., Kumar A., Madzharov S., Handa A.et al.. Use of longitudinal rigid sternal fixation in prevention and treatment of wound complications among high‐risk patients after cardiac surgery. Journal of Cardiac Surgery 2021;36(9):3155-3162. https://doi.org/10.1111/jocs.15687
Sahasrabudhe P., Pradhan M., Panse N., & Jagtap R Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center. Indian Journal of Plastic Surgery 2021;54(02):157-162. https://doi.org/10.1055/s-0041-1731256.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Bariq Zaeem Mirza, . Nasratullah, Waseem Riaz, Mirza Sameer Ahmed Khan, Maria Noor, Muhammad Sooban Qamar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
