Circadian rhythm and daytime variation do not affect intraoperative bacterial sternal contamination and postoperative wound infections following cardiac surgery

Scientific Reports, vol. 14, pp. 26695

Abstract

Studies have documented various effects of circadian rhythm and daytime variations on the cardiovascular and immune system as well as wound healing. From June to December 2016, n = 367 cardiac surgery patients were enrolled. Microbiological swabs from the mediastinum and subcutaneous wound were taken before sternal closure. Patients were assigned to groups based on operation start: morning (n = 219) or afternoon (n = 135). Bacterial contamination and wound infections were studied in relation to circadian rhythm and daytime variation. We did not observe any difference in mortality (morning: 3.7%, afternoon: 3.0%, p > 0.99) and major adverse events (morning: 8.2%, afternoon: 5.9%, p = 0.53). In 27.7% of the morning group, at least one positive intraoperative swab was observed, similar to the afternoon group (25.6%, p = 0.71). The incidence of positive presternal swabs was 15.6% in the morning compared to 9.1% in the afternoon (p = 0.18). About 90% of the germs detected were part of the natural skin flora (e.g., Cutibacterium acnes and Staphylococcus epidermidis). The incidence of sternal wound infections was 7.3% (morning) and 3.0% (afternoon) (p = 0.18). We did not find differences in the incidence of intraoperative bacterial sternal contamination, nor postoperative infections, between patients who underwent cardiac surgery in the morning or afternoon.

Authors 5

1. Moritz Benjamin Immohr corresponding Aachen Medical Faculty Department of Cardiac Surgery

   RWTH Aachen University · Essen University Hospital · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany. Moritz.Immohr@uk-essen.de

   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Medical Faculty and University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 405147, Essen, Germany. Moritz.Immohr@uk-essen.de

   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Medical Faculty and University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 405147, Essen, Germany

2. Yukiharu Sugimura Aachen Medical Faculty Department of Cardiac Surgery

   RWTH Aachen University · Essen University Hospital · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Medical Faculty and University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 405147, Essen, Germany

3. Ajay Kumar Moza Aachen Medical Faculty Department of Cardiac Surgery

   RWTH Aachen University

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany

4. Payam Akhyari Aachen Medical Faculty Department of Cardiac Surgery

   RWTH Aachen University · Essen University Hospital · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Medical Faculty and University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 405147, Essen, Germany

5. Ali Aljalloud Aachen Medical Faculty Department of Cardiac Surgery

   RWTH Aachen University

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany

   Department of Cardiology, Nephrology and Internal Intensive Care, Rhein-Maas Hospital, Würselen, Germany