Surgical-Site Infections After Coronary Artery Bypass Graft Surgery: Discriminating Site-Specific Risk Factors to Improve Prevention Efforts

The story of the surgical treatment of cardiac lesions, either traumatic, congenital, degenerative, or postinfective, is almost entirely a 20th-century story.Experimental cardiac surgery began more than 100 years ago with M.H. Block, a German surgeon, who published a report on wounds of the heart in 1882, in which he described suture of rabbit hearts.He strongly urged that the procedure be used in man. 1 At that time, Billroth is reported to have said: "A surgeon who would attempt such an operation should lose the respect of his colleagues." 1 Nevertheless, in 1896, Ludwig Rehn of Frankfort became the first surgeon to suture a human heart laceration successfully, thus inaugurating the era of cardiac surgery. 1 Nowadays, with an estimated 468,000 coronary artery bypass grafts (CABGs) performed each year in the United States, 2 cardiac surgery has become the "epitome of contemporary high-technology medical care." 3 Approximately 2% to 20% of CABGs are complicated by a surgical-site infection (SSI).4,5 Much of the literature on SSI following cardiothoracic surgical procedures focus on deep chest infections, which, although not frequent (complicating 0.5% to 5% of cardiac procedures 4,5 ), are important because of the high morbidity, mortality, and immense costs they add to the healthcare system.Host, surgical, and microbiological risk factors are intertwined in a complex way for an SSI to develop.Extremes of age, prolonged preoperative stay, remote infection, and duration of surgery are some of the risk factors that have been associated consistently with SSI. 6For patients undergoing cardiac surgery, the median sternotomy and the extracorporeal circulation both cause considerably greater stress on the host defenses than general surgical procedures.3,7,8 RISK FACTORS FOR SURGICAL-SITE INFECTION OF THE STERNAL WOUND