A National Study of the Impact of Delayed Flap Timing for Treatment of Patients with Deep Sternal Wound Infection.

Background: This study aims to evaluate the impact of delayed flap closure on mortality and resource utilization for treatment of deep sternal wound infection (DSWI). Methods: We analyzed the Truven MarketScan Databases from 2009 - 2013 to identify adult patients who developed DSWI after open cardiac surgery and who received flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing. Multivariable Poisson regressions were utilized to investigate the relationship between flap timing and number of procedures, number of hospitalizations, and length of stay (LOS) outcomes. A multivariable log-linear regression model was created for cost analysis. All analyses were adjusted for patient risk factors and treatment characteristics. Results: We identified 612 patients with DSWI who underwent flap closure. The timing of flap closure was delayed >7 days after diagnosis in 39% of patients. Delayed time to flap closure >3 days after diagnosis of DSWI was associated with higher mortality odds (4-7 days OR 2.94; >7 days OR 2.75, P7 days IRR 1.93, P

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