Reducing sternal wound infections after cardiac surgery through targeted, interdisciplinary efforts: A large, single-center experience.

Abstract

Sternal wound infections (SWIs) are associated with significant morbidity, mortality, and healthcare costs. Following root-cause analysis, our center implemented an evidence-based SWI prevention bundle and evaluate its effect on the SWI burden. Adult patients undergoing coronary artery bypass grafting and/or valve surgery via median sternotomy between 2021 and 2024 were reviewed (N=2185). Patients were stratified by era (pre- vs. post-bundle). Propensity score matching yielded two groups of 802 patients. The primary outcome was deep SWI as defined by the National Healthcare Safety Network. Matched groups were similar across key baseline variables. The SWI rate decreased from 2.7% pre-bundle to 1.1% post-bundle (P=0.03), driven by a threefold reduction in deep SWIs (2.1% vs 0.7%, P=0.04). Superficial SWIs were unchanged (0.6% vs 0.3%, P=0.87). Thirty-day readmissions also decreased (1.3% vs. 0.4%, P=0.01). Multivariable analysis identified diabetes, higher body mass index, and the pre-bundle era as predictors of SWI. A greater number and proportion of culture isolates were fungal in the post-bundle era (33% vs. 9.1%, P=0.047). Implementation of a SWI prevention bundle significantly reduced deep SWIs and associated readmissions. The relative increase in fungal infections highlights the need for targeted strategies against Candida species.