Bilateral mammary artery grafting increases postoperative mediastinitis without survival benefit in obese patients
Bibliographic record
Abstract
OBJECTIVES: The prevalence of obesity has risen in the last decade, increasing the percentage of obese patients who undergo cardiac surgery. Deep sternal wound infection (DSWI) is a rare but devastating postoperative complication, more often encountered in the obese population. DSWI is also associated with the use of bilateral internal mammary artery (BIMA), particularly in this high-risk population. The aim of this study is to determine the short-term and long-term outcomes following BIMA revascularization in obese patients. METHODS: This is a single-centre retrospective cohort study using prospectively collected data including all obese patients who underwent coronary artery bypass grafting (CABG) surgery between April 1991 and April 2014. Preoperative demographic characteristics, operative and postoperative variables were taken from the computerized database of the hospital. A propensity score matching was conducted for the short- and long-term outcomes in the entire study population. RESULTS: underwent CABG during the studied period. After propensity scoring, 494 patients receiving BIMA were matched to 5089 patients receiving single internal mammary artery (SIMA). All preoperative characteristics were comparable except for a higher prevalence of left ventricular dysfunction and left main disease as well as higher mean EuroSCORE in the SIMA group. In the postoperative period, short-term mortality was comparable in the two groups (P = 0.68). In-hospital DSWI was also comparable (P = 0.10). However, when considering DSWI occurring after hospitalization (median time; 19 days), the latter was significantly lower in the SIMA than in the BIMA group (1.1 vs 3.2%; P < 0.0001). For long-term survival, no difference was observed between the BIMA and SIMA groups after appropriate matching (P = 0.22). CONCLUSIONS: In obese patients, CABG surgery using BIMA instead of SIMA increased the risk of postoperative DSWI, without improving survival. According to our results, short-term postoperative risks of infection associated with BIMA are not offset by longer-term benefits in that patient population. Special care should be exerted when selecting conduits for myocardial revascularization in obese patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".