Treatment of Cardiac Surgical Wounds with Silver Dressings

Introduction. Mediastinitis is a deadly surgical site infection (SSI) after cardiac surgery. Although rare, mortality is as high as 47%. Best practices for infection prevention to eliminate this deadly complication must be identified. Surgical dressings impregnated with silver have been shown to reduce SSIs in other surgical specialties. This aim of this study is to determine if the routine use of silver surgical dressings is beneficial to prevent mediastinitis after cardiac surgery. Methods. A single-center retrospective study was performed on patients who underwent sternotomy from 2016 to 2018 at the University of Kansas Medical Center. Prior to June 2017, all cardiac surgical patients were treated with gauze surgical dressings and is designated Group A. The routine use of silver-impregnated surgical dressings was implemented in June 2017, patients after this change in practice are designated Group B. Patient characteristics and rates of deep and superficial sternal wound infections (SWI) were compared.  Results. There were 464 patients in Group A and 505 in Group B. There were seven SWIs in Group A (7/464, 1.5%) and five in Group B (5/505, 1%; p = 0.57). Of these, there was one deep SWI per group (p = 0.61) and six superficial SWIs in Group A compared to four in Group B (p = 0.74). Severe COPD was higher in Group A (p = 0.04) and peak glucose was higher in Group B (p = 0.02).  Conclusions.The analysis conferred no benefit with silver-impregnated surgical dressings to prevent mediastinitis. Choice of gauze surgical dressings may be preferable to reduce cost

Secondary prevention following coronary artery bypass surgery: a pilot study for improved patient education

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Gait Speed Is Not Associated with Vasogenic Shock or Cardiogenic Shock following Cardiac Surgery, but Is Associated with Increased Hospital Length of Stay

Objective. Frailty has been associated with adverse outcomes following cardiac surgery. Gait speed has been validated as a marker of frailty. Slow gait speed has been found to be associated with mortality after cardiac surgery. However, it is unknown why slow gait speed predisposes to cardiac surgical mortality. Design. A retrospective analysis. Participants. Patients undergoing cardiac surgery who had a 5-meter walk test performed preoperatively (n=333 of 1735 total surgical patients) from January 2013 to March 2017. Setting. A tertiary care academic hospital. Measurements and main results. Gait speeds were stratified by tertiles: 1 m/s. There was no difference in the incidence of cardiogenic or vasogenic shock when comparing the gait speed groups. Total hospital length of stay was significantly different among the gait speed groups (p=0.0050). Also, patients in the slowest gait speed tertile had a significant association with need for a postoperative permanent pacemaker (p=0.0298). Conclusion. There was no significant association between gait speed and the incidence of cardiogenic or vasogenic shock after cardiac surgery. Gait speed was associated with increased hospital length of stay and need for a permanent pacemaker after cardiac surgery