Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Brazilian Journal of Cardiovascular Surgery (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382011000200007 |
Resumo: | BACKGROUND: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. OBJECTIVE: To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied. RESULTS: The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA. CONCLUSIONS: We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA. |
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Brazilian Journal of Cardiovascular Surgery (Online) |
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Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patientsMediastinitisMyocardial RevascularizationDiabetes MellitusMammary ArteriesBACKGROUND: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. OBJECTIVE: To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied. RESULTS: The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA. CONCLUSIONS: We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA.Sociedade Brasileira de Cirurgia Cardiovascular2011-06-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382011000200007Brazilian Journal of Cardiovascular Surgery v.26 n.2 2011reponame:Brazilian Journal of Cardiovascular Surgery (Online)instname:Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV)instacron:SBCCV10.1590/S0102-76382011000200007info:eu-repo/semantics/openAccessSá,Michel Pompeu Barros de OliveiraSoares,Evelyn FigueiraSantos,Cecília AndradeFigueiredo,Omar JacobinaLima,Renato Oliveira AlbuquerqueEscobar,Rodrigo RendaRueda,Fábio Gonçalves deFerraz,Paulo ErnandoLima,Ricardo Carvalhoeng2011-08-25T00:00:00Zoai:scielo:S0102-76382011000200007Revistahttp://www.rbccv.org.br/https://old.scielo.br/oai/scielo-oai.php||rosangela.monteiro@incor.usp.br|| domingo@braile.com.br|| brandau@braile.com.br1678-97410102-7638opendoar:2011-08-25T00:00Brazilian Journal of Cardiovascular Surgery (Online) - Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV)false |
dc.title.none.fl_str_mv |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
title |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
spellingShingle |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients Sá,Michel Pompeu Barros de Oliveira Mediastinitis Myocardial Revascularization Diabetes Mellitus Mammary Arteries |
title_short |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
title_full |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
title_fullStr |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
title_full_unstemmed |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
title_sort |
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients |
author |
Sá,Michel Pompeu Barros de Oliveira |
author_facet |
Sá,Michel Pompeu Barros de Oliveira Soares,Evelyn Figueira Santos,Cecília Andrade Figueiredo,Omar Jacobina Lima,Renato Oliveira Albuquerque Escobar,Rodrigo Renda Rueda,Fábio Gonçalves de Ferraz,Paulo Ernando Lima,Ricardo Carvalho |
author_role |
author |
author2 |
Soares,Evelyn Figueira Santos,Cecília Andrade Figueiredo,Omar Jacobina Lima,Renato Oliveira Albuquerque Escobar,Rodrigo Renda Rueda,Fábio Gonçalves de Ferraz,Paulo Ernando Lima,Ricardo Carvalho |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Sá,Michel Pompeu Barros de Oliveira Soares,Evelyn Figueira Santos,Cecília Andrade Figueiredo,Omar Jacobina Lima,Renato Oliveira Albuquerque Escobar,Rodrigo Renda Rueda,Fábio Gonçalves de Ferraz,Paulo Ernando Lima,Ricardo Carvalho |
dc.subject.por.fl_str_mv |
Mediastinitis Myocardial Revascularization Diabetes Mellitus Mammary Arteries |
topic |
Mediastinitis Myocardial Revascularization Diabetes Mellitus Mammary Arteries |
description |
BACKGROUND: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. OBJECTIVE: To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied. RESULTS: The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA. CONCLUSIONS: We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA. |
publishDate |
2011 |
dc.date.none.fl_str_mv |
2011-06-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382011000200007 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382011000200007 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S0102-76382011000200007 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cirurgia Cardiovascular |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cirurgia Cardiovascular |
dc.source.none.fl_str_mv |
Brazilian Journal of Cardiovascular Surgery v.26 n.2 2011 reponame:Brazilian Journal of Cardiovascular Surgery (Online) instname:Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV) instacron:SBCCV |
instname_str |
Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV) |
instacron_str |
SBCCV |
institution |
SBCCV |
reponame_str |
Brazilian Journal of Cardiovascular Surgery (Online) |
collection |
Brazilian Journal of Cardiovascular Surgery (Online) |
repository.name.fl_str_mv |
Brazilian Journal of Cardiovascular Surgery (Online) - Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV) |
repository.mail.fl_str_mv |
||rosangela.monteiro@incor.usp.br|| domingo@braile.com.br|| brandau@braile.com.br |
_version_ |
1752126597544017920 |