Characterization of Sternal Wound Infections After Median Sternotomy in Cardiac Surgery Patients

Introduction: A sternotomy is the standard approach in patients undergoing cardiac surgery. Sternal wound infections are a potential complication of a sternotomy with an associated mortality of up to 30%. There are known risk for sternal wound infections previously published. The objectives of this project are to characterize sternal wound infections in cardiac surgery patients at Virginia Commonwealth University Medical Center and to identify areas for quality improvement in the perioperative setting with a focus on glucose control, corticosteroid use, and antimicrobial exposure.


Methods: This was a retrospective, observational, single-center, quality improvement project. Patients who underwent cardiac surgery from January 1, 2022 to September 1, 2024 were identified using an internal cardiac surgery database. Patients who developed sternal wound infection were compared to those that did not. For each sternal wound patient, we aimed to identify four non-sternal wound patients with the same procedure type. Patients who received heart transplantation or permanent mechanical circulatory support, and those without sternotomy were excluded.


Results: Overall, 153 patients were included in the study with 32 sternal wound infections. Baseline characteristics between groups were similar between both groups. The sternal wound group had a longer mean operative time (422.34 mins vs 375.2 mins, p=0.014) and were more likely to return to the operating room (31.3% vs 9.1%, p=0.003). There were no statistical differences with regards to perioperative glucose control or corticosteroid use. Patients who developed sternal wound infections had increased post-operative antimicrobial exposure beyond surgical prophylaxis (46.9 vs 23.1% p=0.008). Of those that received additional antimicrobials, 53% within both groups were empirically initiated. Open chest prophylaxis accounted for 50% of the empiric use in the sternal wound group and 20% in those without sternal wounds.


Conclusions: This quality improvement project showed several procedural differences that could be contributing to the development of sternal wound infections; however, perioperative glucose control and use of corticosteroids was similar between both groups. There was significantly more post-operative antimicrobial exposure in those that developed sternal wounds.