A National Study of the Impact of Delayed Flap Timing for Treatment of Patients with Deep Sternal Wound Infection
Erika D. Sears, MD, MS, Lizi Wu, PhD, Jennifer F. Waljee, MD, MPH, Adeyiza O. Momoh, MD, Lin Zhong, MD, MPH, Kevin C. Chung, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
Purpose: This study aims to evaluate the impact of delayed flap closure on mortality and associated outcomes for treatment of deep sternal wound infection (DSWI).
Methods: We analyzed the Truven MarketScan Databases from 2009 – 2013 to identify adult patients who developed DSWI after open cardiac surgery and received flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing. Multivariable Poisson regressions were utilized to evaluate the relationship between flap timing and number of procedures, number of hospitalizations, and length of stay (LOS) outcomes. A multivariable log-linear regression model was created for cost analysis. All analyses were adjusted for patient risk factors and treatment characteristics.
Results: 1,335 patients were identified with DSWI and received surgical treatment. Of patients receiving surgical treatment, 46% (n = 612) underwent flap closure. The timing of flap closure was >3 days after diagnosis of DSWI in 61% of patients and >7 days in 39% of patients. Delayed time to flap closure >3 days after diagnosis of DSWI was associated with higher mortality odds (4-7 days OR 2.94; >7 days OR 2.75, P<0.03), greater additional procedures (4-7 days IRR 1.72; >7 days IRR 1.93, P<0.001), up to 43% longer hospital LOS, and 37% greater costs compared to patients having earlier flap closure.
Conclusion: Delay in flap closure was associated with greater mortality and resource utilization. Prompt involvement of reconstructive surgeons can improve quality and efficiency of DSWI care.
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