COMPARISON OF INCIDENCE OF POSTOPERATIVE STERNOTOMY SURGICAL SITE INFECTIONS AND IMPACT OF SUTURE TYPE (ABSORBABLE OR NON-ABSORBABLE) ON ITS FREQUENCY
Main Article Content
Keywords
Surgical site infections, SSIs, 4-0 Vicryl, Prolene, elective surgeries
Abstract
Introduction: Surgical site infections (SSIs) are associated with adverse outcomes in cardiac surgery patients and sutures can get infected at the surgery table. Median sternotomy is a delicate procedure carrying high risk of SSIs. It is important to study SSIs associated with types of sutures used in sternotomy procedure.
Methodology: To compare the incidence of SSIs associated with type of suture, Prolene was used in one and 4-0 Vicryl in the second group (each n=33) and data was analyzed prospectively over a six-month period. Only elective procedures were included, and the data was analyzed on SPSS version 25.0.
Results: Females comprised 36.4% of study population of mean age of 51.18 years. A total of 11 cases of infection were reported out of which 7 cases belonged to Prolene group.
Conclusion: The number of infections in 4-0 Vicryl group was lesser than the Prolene group indicating the safety of the Vicryl material.
References
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2. Correnti C, Blankenship K, Ufkes N, Strasswimmer J. Sutures, Adhesives, Staples, and Other Closure Technologies BT - Evidence-Based Procedural Dermatology. In: Alam M, editor. Cham: Springer International Publishing; 2019. p. 175–212. Available from: https://doi.org/10.1007/978-3-030-02023-1_13
3. Wang B, He D, Wang M, Qian Y, Lu Y, Shi X, et al. Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres. J Cardiothorac Surg. 2019 Nov;14(1):193.
4. D’Cunha P, Pande B, Kathalagiri MS, Moharana AK, S. DT, Pinto CS. Absorbable sutures: chronicles and applications. Int Surg J. 2022;9(7):1383.
5. Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B, et al. Global Incidence of Surgical Site Infection Among Patients: Systematic Review and Meta-Analysis. Inquiry. 2023;60:469580231162549.
6. Birhanu A, Amare HH, G/Mariam M, Girma T, Tadesse M, Assefa DG. Magnitude of surgical site infection and determinant factors among postoperative patients, A cross sectional study. Ann Med Surg. 2022 Nov;83:104324.
7. Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, et al. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. Int J Surg. 2021 Nov;95:106136.
8. Suelo-Calanao RL, Thomson R, Read M, Matheson E, Isaac E, Chaudhry M, et al. The impact of closed incision negative pressure therapy on prevention of median sternotomy infection for high risk cases: a single centre retrospective study. J Cardiothorac Surg [Internet]. 2020;15(1):222. Available from: https://doi.org/10.1186/s13019-020-01265-1
9. Sharif M, Wong CHM, Harky A. Sternal Wound Infections, Risk Factors and Management – How Far Are We? A Literature Review. Hear Lung Circ [Internet]. 2019;28(6):835–43. Available from: https://www.sciencedirect.com/science/article/pii/S1443950619300435
10. Chua RAHW, Lim SK, Chee CF, Chin SP, Kiew L V., Sim KS, et al. Surgical site infection and development of antimicrobial sutures: A review. Eur Rev Med Pharmacol Sci. 2022;26(3):828–45.
11. Traylor LB, Bhatia G, Blackhurst D, Wallenborn G, Ewing A, Bolton W, et al. Efficacy of incisional negative pressure therapy in preventing post-sternotomy wound complications. Am J Surg [Internet]. 2023; Available from: https://www.sciencedirect.com/science/article/pii/S0002961023003306
12. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008 Jun;36(5):309–32.
13. ASEPSIS Score for Postoperative Wound Infections - Equation _ Medicalalgorithms [Internet]. [cited 2023 Nov 2]. Available from: https://www.medicalalgorithms.com/the-asepsis-scoring-method-for-postoperative-wound-infections
14. Buja A, Zampieron A, Cavalet S, Chiffi D, Sandonà P, Vinelli A, et al. An update review on risk factors and scales for prediction of deep sternal wound infections. Int Wound J [Internet]. 2012 Aug 1;9(4):372–86. Available from: https://doi.org/10.1111/j.1742-481X.2011.00896.x
15. Ogawa R. [Cause and prevention of surgical site infection and hypertrophic scars]. Kyobu Geka. 2012 Mar;65(3):237–43.
16. Iida H, Sunazawa T, Doi A. [Feasibility of the use of absorbable sutures for closure of the sternum in adult cardiac surgery]. Kyobu Geka. 2013 Dec;66(13):1145–8.
17. Thimour-Bergström L, Roman-Emanuel C, Scherstén H, Friberg Ö, Gudbjartsson T, Jeppsson A. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†. Eur J Cardio-Thoracic Surg [Internet]. 2013 Nov 1;44(5):931–8. Available from: https://doi.org/10.1093/ejcts/ezt063
18. Shiferaw WS, Aynalem YA, Akalu TY, Petrucka PM. Surgical site infection and its associated factors in Ethiopia: a systematic review and meta-analysis. BMC Surg. 2020 May;20(1):107.
19. Berg TC, Kjørstad KE, Akselsen PE, Seim BE, Løwer HL, Stenvik MN, et al. National surveillance of surgical site infections after coronary artery bypass grafting in Norway: incidence and risk factors. Eur J Cardio-Thoracic Surg [Internet]. 2011 Dec 1;40(6):1291–7. Available from: https://doi.org/10.1016/j.ejcts.2011.02.038
20. Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, et al. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study. Ther Adv Infect Dis. 2022;9:20499361221135130.
21. Lakoh S, Yi L, Sevalie S, Guo X, Adekanmbi O, Smalle IO, et al. Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study. Antimicrob Resist Infect Control. 2022 Feb;11(1):39.
22. Ahmed I, Boulton AJ, Rizvi S, Carlos W, Dickenson E, Smith NA, et al. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open [Internet]. 2019;9(9). Available from: https://bmjopen.bmj.com/content/9/9/e029727
23. Wang ZX, Jiang CP, Cao Y, Ding YT. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg [Internet]. 2013 Mar 1;100(4):465–73. Available from: https://doi.org/10.1002/bjs.9062
24. Daoud FC, Edmiston CE, Leaper D. Meta-Analysis of Prevention of Surgical Site Infections following Incision Closure with Triclosan-Coated Sutures: Robustness to New Evidence. Surg Infect (Larchmt) [Internet]. 2014 Apr 16;15(3):165–81. Available from: https://doi.org/10.1089/sur.2013.177
25. Stadler S, Fleck T. Triclosan-coated sutures for the reduction of sternal wound infections? A retrospective observational analysis. Interact Cardiovasc Thorac Surg [Internet]. 2011 Sep 1;13(3):296–9. Available from: https://doi.org/10.1510/icvts.2011.269001
26. Durkaya S, Kaptanoglu M, Nadir A, Yilmaz S, Cinar Z, Dogan K. Do absorbable sutures exacerbate presternal scarring? Texas Hear Inst J. 2005;32(4):544–8.
27. Kukulski L, Krawczyk A, Pacholewicz J. Retrospective analysis of the impact of sternum closure technique on postoperative comfort and rehabilitation. Kardiochirurgia i torakochirurgia Pol = Polish J cardio-thoracic Surg. 2018 Dec;15(4):233–7.
28. Işik O, Ipek G, Mansuroğlu D, Berki T, Tuzcu M, Yakut C. Monofilament absorbable sutures in median sternotomy. J Cardiovasc Surg (Torino). 1999 Aug;40(4):615–7.
29. Kawashima M, Sano A, Tanaka M. Sternal closure with absorbable pins and cords in general thoracic surgery. Surg Today. 2015 Jul;45(7):929–31.
30. Tzimas V, Kotsias C, Galanis C, Panagiotakopoulos G, Tsiampas D, Parnis J, et al. Comparative study of surgical wound closure with nylon interrupted sutures and running subcuticular vicryl rapide suture after open release of the carpal tunnel. Scars, Burn Heal. 2022;8:20595131221128950.
31. Steingrimsson S, Thimour-Bergström L, Roman-Emanuel C, Scherstén H, Friberg Ö, Gudbjartsson T, et al. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial. Eur J Clin Microbiol Infect Dis [Internet]. 2015;34(12):2331–8. Available from: https://doi.org/10.1007/s10096-015-2485-8
32. Mulch J, Stertmann WA, Kling D, Scheld HH. Closure of longitudinal sternotomy with absorbable sutures. Thorac Cardiovasc Surg. 1986 Jun;34(3):191–3.
33. Keçeligil HT, Kolbakir F, Akar H, Konuralp C, Demir Z, Demirağ MK. Sternal closure with resorbable synthetic loop suture material in children. J Pediatr Surg. 2000 Sep;35(9):1309–11.
34. Bigdelian H, Sedighi M. Evaluation of sternal closure with absorbable polydioxanone sutures in children. J Cardiovasc Thorac Res. 2014;6(1):57–9.
35. Pastorino U, Muscolino G, Valente M, Andreani S, Tavecchio L, Infante M, et al. Safety of absorbable suture for sternal closure after pulmonary or mediastinal resection. J Thorac Cardiovasc Surg [Internet]. 1994;107(2):596–9. Available from: https://www.sciencedirect.com/science/article/pii/S0022522394701083
36. Tuuli MG, Stout MJ, Martin S, Rampersad RM, Cahill AG, Macones GA. Comparison of suture materials for subcuticular skin closure at cesarean delivery. Am J Obstet Gynecol. 2016 Oct;215(4):490.e1-5.
37. Niessen FB, Spauwen PH, Kon M. The role of suture material in hypertrophic scar formation: Monocryl vs. Vicryl-rapide. Ann Plast Surg. 1997 Sep;39(3):254–60.
38. Loona M, Bhushan R, Grover V, Gupta V. OUTCOMES AND SAFETY OF STERNAL CLOSURE USING NON-ABSORBABLE POLYESTER BRAIDED SUTURE: SINGLE TERTIARY CARE CENTER EXPERIENCE OF 5 YEARS. Int J Sci Res. 2020 Oct 7;
39. Murayama A, Yoneda H, Maehara A, Shiomi N, Hirata H. A highly elastic absorbable monofilament suture fabricated from poly(3-hydroxybutyrate-co-4-hydroxybutyrate). Sci Rep [Internet]. 2023;13(1):3275. Available from: https://doi.org/10.1038/s41598-023-30292-w
2. Correnti C, Blankenship K, Ufkes N, Strasswimmer J. Sutures, Adhesives, Staples, and Other Closure Technologies BT - Evidence-Based Procedural Dermatology. In: Alam M, editor. Cham: Springer International Publishing; 2019. p. 175–212. Available from: https://doi.org/10.1007/978-3-030-02023-1_13
3. Wang B, He D, Wang M, Qian Y, Lu Y, Shi X, et al. Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres. J Cardiothorac Surg. 2019 Nov;14(1):193.
4. D’Cunha P, Pande B, Kathalagiri MS, Moharana AK, S. DT, Pinto CS. Absorbable sutures: chronicles and applications. Int Surg J. 2022;9(7):1383.
5. Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B, et al. Global Incidence of Surgical Site Infection Among Patients: Systematic Review and Meta-Analysis. Inquiry. 2023;60:469580231162549.
6. Birhanu A, Amare HH, G/Mariam M, Girma T, Tadesse M, Assefa DG. Magnitude of surgical site infection and determinant factors among postoperative patients, A cross sectional study. Ann Med Surg. 2022 Nov;83:104324.
7. Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, et al. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. Int J Surg. 2021 Nov;95:106136.
8. Suelo-Calanao RL, Thomson R, Read M, Matheson E, Isaac E, Chaudhry M, et al. The impact of closed incision negative pressure therapy on prevention of median sternotomy infection for high risk cases: a single centre retrospective study. J Cardiothorac Surg [Internet]. 2020;15(1):222. Available from: https://doi.org/10.1186/s13019-020-01265-1
9. Sharif M, Wong CHM, Harky A. Sternal Wound Infections, Risk Factors and Management – How Far Are We? A Literature Review. Hear Lung Circ [Internet]. 2019;28(6):835–43. Available from: https://www.sciencedirect.com/science/article/pii/S1443950619300435
10. Chua RAHW, Lim SK, Chee CF, Chin SP, Kiew L V., Sim KS, et al. Surgical site infection and development of antimicrobial sutures: A review. Eur Rev Med Pharmacol Sci. 2022;26(3):828–45.
11. Traylor LB, Bhatia G, Blackhurst D, Wallenborn G, Ewing A, Bolton W, et al. Efficacy of incisional negative pressure therapy in preventing post-sternotomy wound complications. Am J Surg [Internet]. 2023; Available from: https://www.sciencedirect.com/science/article/pii/S0002961023003306
12. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008 Jun;36(5):309–32.
13. ASEPSIS Score for Postoperative Wound Infections - Equation _ Medicalalgorithms [Internet]. [cited 2023 Nov 2]. Available from: https://www.medicalalgorithms.com/the-asepsis-scoring-method-for-postoperative-wound-infections
14. Buja A, Zampieron A, Cavalet S, Chiffi D, Sandonà P, Vinelli A, et al. An update review on risk factors and scales for prediction of deep sternal wound infections. Int Wound J [Internet]. 2012 Aug 1;9(4):372–86. Available from: https://doi.org/10.1111/j.1742-481X.2011.00896.x
15. Ogawa R. [Cause and prevention of surgical site infection and hypertrophic scars]. Kyobu Geka. 2012 Mar;65(3):237–43.
16. Iida H, Sunazawa T, Doi A. [Feasibility of the use of absorbable sutures for closure of the sternum in adult cardiac surgery]. Kyobu Geka. 2013 Dec;66(13):1145–8.
17. Thimour-Bergström L, Roman-Emanuel C, Scherstén H, Friberg Ö, Gudbjartsson T, Jeppsson A. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†. Eur J Cardio-Thoracic Surg [Internet]. 2013 Nov 1;44(5):931–8. Available from: https://doi.org/10.1093/ejcts/ezt063
18. Shiferaw WS, Aynalem YA, Akalu TY, Petrucka PM. Surgical site infection and its associated factors in Ethiopia: a systematic review and meta-analysis. BMC Surg. 2020 May;20(1):107.
19. Berg TC, Kjørstad KE, Akselsen PE, Seim BE, Løwer HL, Stenvik MN, et al. National surveillance of surgical site infections after coronary artery bypass grafting in Norway: incidence and risk factors. Eur J Cardio-Thoracic Surg [Internet]. 2011 Dec 1;40(6):1291–7. Available from: https://doi.org/10.1016/j.ejcts.2011.02.038
20. Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, et al. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study. Ther Adv Infect Dis. 2022;9:20499361221135130.
21. Lakoh S, Yi L, Sevalie S, Guo X, Adekanmbi O, Smalle IO, et al. Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study. Antimicrob Resist Infect Control. 2022 Feb;11(1):39.
22. Ahmed I, Boulton AJ, Rizvi S, Carlos W, Dickenson E, Smith NA, et al. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open [Internet]. 2019;9(9). Available from: https://bmjopen.bmj.com/content/9/9/e029727
23. Wang ZX, Jiang CP, Cao Y, Ding YT. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg [Internet]. 2013 Mar 1;100(4):465–73. Available from: https://doi.org/10.1002/bjs.9062
24. Daoud FC, Edmiston CE, Leaper D. Meta-Analysis of Prevention of Surgical Site Infections following Incision Closure with Triclosan-Coated Sutures: Robustness to New Evidence. Surg Infect (Larchmt) [Internet]. 2014 Apr 16;15(3):165–81. Available from: https://doi.org/10.1089/sur.2013.177
25. Stadler S, Fleck T. Triclosan-coated sutures for the reduction of sternal wound infections? A retrospective observational analysis. Interact Cardiovasc Thorac Surg [Internet]. 2011 Sep 1;13(3):296–9. Available from: https://doi.org/10.1510/icvts.2011.269001
26. Durkaya S, Kaptanoglu M, Nadir A, Yilmaz S, Cinar Z, Dogan K. Do absorbable sutures exacerbate presternal scarring? Texas Hear Inst J. 2005;32(4):544–8.
27. Kukulski L, Krawczyk A, Pacholewicz J. Retrospective analysis of the impact of sternum closure technique on postoperative comfort and rehabilitation. Kardiochirurgia i torakochirurgia Pol = Polish J cardio-thoracic Surg. 2018 Dec;15(4):233–7.
28. Işik O, Ipek G, Mansuroğlu D, Berki T, Tuzcu M, Yakut C. Monofilament absorbable sutures in median sternotomy. J Cardiovasc Surg (Torino). 1999 Aug;40(4):615–7.
29. Kawashima M, Sano A, Tanaka M. Sternal closure with absorbable pins and cords in general thoracic surgery. Surg Today. 2015 Jul;45(7):929–31.
30. Tzimas V, Kotsias C, Galanis C, Panagiotakopoulos G, Tsiampas D, Parnis J, et al. Comparative study of surgical wound closure with nylon interrupted sutures and running subcuticular vicryl rapide suture after open release of the carpal tunnel. Scars, Burn Heal. 2022;8:20595131221128950.
31. Steingrimsson S, Thimour-Bergström L, Roman-Emanuel C, Scherstén H, Friberg Ö, Gudbjartsson T, et al. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial. Eur J Clin Microbiol Infect Dis [Internet]. 2015;34(12):2331–8. Available from: https://doi.org/10.1007/s10096-015-2485-8
32. Mulch J, Stertmann WA, Kling D, Scheld HH. Closure of longitudinal sternotomy with absorbable sutures. Thorac Cardiovasc Surg. 1986 Jun;34(3):191–3.
33. Keçeligil HT, Kolbakir F, Akar H, Konuralp C, Demir Z, Demirağ MK. Sternal closure with resorbable synthetic loop suture material in children. J Pediatr Surg. 2000 Sep;35(9):1309–11.
34. Bigdelian H, Sedighi M. Evaluation of sternal closure with absorbable polydioxanone sutures in children. J Cardiovasc Thorac Res. 2014;6(1):57–9.
35. Pastorino U, Muscolino G, Valente M, Andreani S, Tavecchio L, Infante M, et al. Safety of absorbable suture for sternal closure after pulmonary or mediastinal resection. J Thorac Cardiovasc Surg [Internet]. 1994;107(2):596–9. Available from: https://www.sciencedirect.com/science/article/pii/S0022522394701083
36. Tuuli MG, Stout MJ, Martin S, Rampersad RM, Cahill AG, Macones GA. Comparison of suture materials for subcuticular skin closure at cesarean delivery. Am J Obstet Gynecol. 2016 Oct;215(4):490.e1-5.
37. Niessen FB, Spauwen PH, Kon M. The role of suture material in hypertrophic scar formation: Monocryl vs. Vicryl-rapide. Ann Plast Surg. 1997 Sep;39(3):254–60.
38. Loona M, Bhushan R, Grover V, Gupta V. OUTCOMES AND SAFETY OF STERNAL CLOSURE USING NON-ABSORBABLE POLYESTER BRAIDED SUTURE: SINGLE TERTIARY CARE CENTER EXPERIENCE OF 5 YEARS. Int J Sci Res. 2020 Oct 7;
39. Murayama A, Yoneda H, Maehara A, Shiomi N, Hirata H. A highly elastic absorbable monofilament suture fabricated from poly(3-hydroxybutyrate-co-4-hydroxybutyrate). Sci Rep [Internet]. 2023;13(1):3275. Available from: https://doi.org/10.1038/s41598-023-30292-w
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Nov 11, 2023
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Raja Umer Ejaz, Brig Nasir, & Amna Akbar. (2023). COMPARISON OF INCIDENCE OF POSTOPERATIVE STERNOTOMY SURGICAL SITE INFECTIONS AND IMPACT OF SUTURE TYPE (ABSORBABLE OR NON-ABSORBABLE) ON ITS FREQUENCY. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 2029–2037. https://doi.org/10.53555/jptcp.v30i18.3350
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Author Biographies
Raja Umer Ejaz
Resident Cardiac Surgery, AFIC/NIHD, Rawalpindi
Brig Nasir
Prof Cardiac Surgery, AFIC/NIHD, Rawalpindi, MBBS, FCPS Gen Surgery, FCPS Cardiac Surgery
Amna Akbar
Female Medical Officer, District Headquarter Hospital, Hattian Bala, AJK, Pakistan