The odds ratio (OR) for a surgical site infection is 2.03 in cardiac patients with diabetes compared with OR 1.53 in other types of surgery
The increased risk of sternal wound infections in patients with diabetes was confirmed by a publication last month in the Journal of Infection Control & Hospital Epidemiology: Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Martin ET, Kaye KS, Knott C, et al. (Volume 37 / Issue 01 / January 2016, pp 88-99)
Surgical site infections (SSI) are the most common cause for hospital-acquired infections and have a significant effect on healthcare costs. It routinely leads to re-hospitalization for which hospitals can get penalised by the CMS (Centers for Medicare and Medicaid Services) and lose reimbursement.
The annual healthcare cost of SSI’s is more than $3 billion in the US.
Precautions to prevent surgical site infections in all diabetic patients undergoing surgery are important, however, diabetic cardiac patients are exposed to a significantly higher risk for getting a deep sternal wound infection with potentially devastating outcomes (mortality up to 50%).
Surgical Site Infection Guidelines and Precautions in the Postoperative Period
The Infectious Disease Society of America has published guidelines for the prevention of surgical site infections. They recommend perioperative glucose control as a method to reduce the risk of infection. Likewise, in draft guidelines from the Healthcare Infection Control Practices Advisory Committee a strong recommendation is given to control glucose in all patients undergoing surgery.
These guidelines focus on prevention during surgery. Since it is confirmed that cardiac diabetic patients are at significantly higher odds for sternal wound infections, precaution guidelines should include the postoperative period and the weeks after discharge until the sternum has completely healed. Particularly in view of the fact that between 50 to 80% of SSI are reported to be discovered up to 90 days after discharge [*].
External sternum supports have been shown to decrease deep sternal wound infections among many other benefits for patients [*], and ought to be included in routine precaution guidelines for cardiac patients. Supporting the sternum with a comfortable external support such as QualiBreath [*] is an inexpensive, simple adjunctive method to help preventing devastating infections in all cardiac patients and should be standard practice, particularly for patients with diabetes.
Diabetes is just one of the many risk factors and patients that are considered to be in the high risk group for developing postoperative complications can be identified with the following risk factors and are recommended to wear QualiBreath immediately after surgery continuously for 6 to 8 weeks.
Do you agree that precaution guidelines should include the postoperative period and the weeks after discharge?
Let us know what you think in a comment.
[*] A complete list of literature references are listed in the White Paper: “Evaluation of External Chest Supports Based on the Entire Recovery Process in and out of the Hospital to Avoid Offset Costs of Long Term Complications and Medications”.