The Burden of Sternal Wound Infections After Coronary Artery Bypass Graft Surgery: A Healthcare Simulation Study

Prof Ramon Shaban1, Dr Rhodri Saunders2

1The University of Sydney and Western Sydney Local Health District, Sydney, Australia, 2Coreva Scientific, Koenigswinter, Germany


Sternal wound infection (SWI) following coronary artery bypass graft surgery (CABG) is an infrequent but potentially costly event. The burden of CABG-related SWIs is unknown as is the cost-consequence of implementing single-patient use electrocardiogram (spECG) cable and lead systems to help prevent SWIs.


An integrative literature review identified data on SWIs following CABG. Data use was two-fold, estimating (1) the total national impact of SWIs and (2) the cost-consequence of implementing new practices to reduce the SWI rate at a single hospital. Calculations used a 1-year Markov simulation, whose patients were mean: 68 years, 25% female, and 33% obese.

The simulated pathway included CABG, intensive care unit (ICU), general ward, and discharge. At any stage a patient could develop an SWI. SWI and deep SWI (DSWI) increased length of stay (LOS). Outpatient SWI resulted in readmission or outpatient care.


From literature, the 30-day SWI rate was 3.6%, with 36% being DSWI. Additional LOS was 7.5 and 42.4 days, respectively. We estimate that SWI costs Australian hospitals A$25 million annually, including 7,500 additional ward (1,276 ICU) days.

For a hospital, the estimated mean per patient time in hospital was 8.8 days, costing A$39,938. spECG reduces the odds of a SWI by 0.74 (0.63-0.88). Implementing this technology at an incremental cost of A$10.6 per case would save A$505 per patient, a 47-fold return on investment. The major cost driver was additional LOS associated with DSWI.


CABG-related SWIs are a substantial burden, which may be reduced through implementing spECG.


Professor Shaban is the Inaugural Clinical Chair and Professor of Infection Prevention and Control at the University of Sydney and Western Sydney Local Health District, within the Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity.

As an expert infection control practitioner and emergency nurse. His inter-professional expertise in infectious diseases, infection control and emergency care forms the basis of a highly successful and integrated program of teaching, practice, and research. Professor Shaban is a member of the Australian Government Strategic and Technical Advisory Group on Antimicrobial Resistance, a member of the Australian Commission on Safety and Quality in Healthcare: Healthcare-associated Infection Advisory Committee and is a past President of the Australasian College for Infection Prevention. He is a delegate member representative to the WHO Global Outbreak and Response Network.

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