Economic aspects of deep sternal wound infections☆

Graf, Karolin; E, Ott; Vonberg, Ralf‐Peter; Kuehn, C.; Haverich, Axel; Chaberny, Iris F.

doi:10.1016/j.ejcts.2009.10.005

Cited by 158 publications

(140 citation statements)

References 14 publications

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“…Furthermore, Cabbabe et al 16) found patients undergoing one step radical debridement with muscle flap coverage had significantly shorter hospital stay and lower mortality compared to patients with DSWI who were referred to flap coverage after undergoing extended management by the thoracic surgeons. With the substantial increased cost of care for patients with DSWI, 22) interdisciplinary teamwork regarding the possibility of a flap reconstruction should, in our opinion, be conducted at an early stage after the DSWI diagnosis. The in-hospital mortality rate for patients undergoing flap reconstruction in our study was 7.4% (n = 4), which is a little higher than the 2.7%-5.4% mortality rate reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis

Juhl

Hody

Videbaek

et al. 2017

ATCS

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Section: Discussionmentioning

confidence: 99%

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis

Juhl

Hody

Videbaek

et al. 2017

ATCS

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“…Moreover, the occurrence of mediastinitis exerts a negative impact on the ensuing survival of patients and on hospital costs 4 .…”

Section: Mediastinitis Is a Deep Sternal Wound Infectionmentioning

confidence: 99%

Scintigraphic imaging with technetium-99M-labelled ceftizoxime is a reliable technique for the diagnosis of deep sternal wound infection in rats

et al. 2015

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PURPOSE:To evaluate whether scintigraphy with technetium-99m-labeled ceftizoxime ( Tc-CFT to infected sternums was greater than to their non-infected counterparts. Mean counts of radioactivity in bacteria-infected sternal regions (SB and SWB) were significantly higher (p = 0.0007) than those of the respective controls (S and SW). CONCLUSION:Scintigraphy with technetium-99m-labeled ceftizoxime is a method that can potentially detect infection post sternotomy and differentiate from aseptic inflammation in animals experimentally inoculated with S. aureus.

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“…In a 10-year follow-up study after coronary artery bypass grafting, the adjusted survival rate was 39% for patients who developed DSWI compared with 70% in patients who did not [14] . Excess costs arise primarily owing to additional antibiotic treatments and surgical procedures, as well as increased hospital length of stay [13,15] . The management of DSWI has progressed through long-lasting clinical experience.…”

Section: Introductionmentioning

confidence: 99%

“…Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI.…”

Section: Introductionmentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid-and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors -when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4(4): 265-273 Available from: URL: http:// www.wjgnet.com/2220-3141/full/v4/i4/265.htm DOI: http:// dx.doi.org/10.5492/wjccm.v4.i4.265 INTRODUCTIONDeep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery with a significant impact on both patient prognosis and hospital budgets [1][2][3][4][5] . Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI. By the end of the first year, Filsoufi et al [6] found a 15% absolute survival difference between patients ...

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Economic aspects of deep sternal wound infections☆

Abstract: DSWI represents an important economic factor for the hospital as they may almost triple the costs for patients undergoing CABG. Thus, appropriate infection control measures for the prevention of DSWI should be enforced.

Cited by 158 publications

References 14 publications

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis

Scintigraphic imaging with technetium-99M-labelled ceftizoxime is a reliable technique for the diagnosis of deep sternal wound infection in rats

Deep sternal wound infection after cardiac surgery: Evidences and controversies

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