Original article: general thoracicVariables predicting adverse outcome in patients with deep sternal wound infection
Section snippets
Patients and methods
Between January 1979 and January 1999, 13,420 patients underwent open heart surgery through a complete median sternotomy at our institution: the perioperative protocol of infection control remained almost unchanged over the years.
Elective patients were showered and shaved the day of their operation. In all cases, since the morning of the operation, patients received intravenous cephalosporins and intramuscolar aminoglycosides, until central line and drains were removed.
The operative field was
Results
Nineteen patients (16.9%) died during their hospital stay. Causes of death included sepsis in 8 cases, respiratory failure in 4, multiorgan failure in 4, massive bleeding from the aortic cannulation site in 1 and from right ventricular tear in 1, and cardiac failure in 1.
Wound healing was observed in 93 cases. Hospital stay ranged between 16 and 180 days (mean 31.3 ± 15.2). Germs isolated from wound secretions or from mediastinal fluid are reported in Table 2.
Follow-up time ranged between 6
Comment
Mediastinal infection is a dreadful complication of open-heart surgery. Simple medical treatment is often ineffective; infection may cause septicemia or propagate to the cardiac sutures leading to massive hemorrhage 1, 2. Reoperation is mandatory; nevertheless infection may continue, leading to local and systemic complications. Treatment is distressing for both the patient and the surgeon, because the rate of failure is high and the dressing may be painful and time consuming. Hospitalization
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