The Risk Factors of Median Sternotomy Infection: A Current Review

Abstract

Sternal sepsis following median sternotomy is an infrequent yet devastating complication of cardiac surgery, leading to prolonged hospitalization, increased hospital expense, and a high associated morbidity and mortality. The development of sternotomy infection is multifactorial. Numerous prospective and retrospective studies have pointed to a multitude of clinical and perioperative variables as being causative, with as many other studies presenting evidence of the contrary. This has led to confusion about which clinical variables should be modified so as to minimize the individual patient's risk for developing this severe complication. Other less obvious factors also come into play. Malnutrition, whether overt or subclinical, is not uncommon in cardiac patients. Immune competency is affected by operative trauma, as well as a variety of perioperative factors including underlying nutritional status, transfusion, cardiopulmonary bypass, and anesthesia. This creates a complex milieu for the development of postoperative infection. In this review, the multiple risk factors of median sternotomy infection are studied and treatment options briefly discussed.

Preditores de mediastinite em cirurgia cardíaca

“…In our study, the factors considered independent predictors of potential risk of mediastinitis were obesity, COPD and diabetes Mellitus. According to the reviewed data, among all the risk factors, obesity seems to be the most important independent risk factor for mediastinitis, as has already been demonstrated in several studies [2,5,[15][16][17][18][19][20]. In the Parisian Mediastinitis Study Group Risk Factors for Deep Sternal Wound Infective [21] obesity was the only independent preoperative risk factor for mediastinitis.…”

Bacteriological Evaluation of the Cardiac Surgery Environment Accompanying Hospital Relocation

“…According to our review of the literature, the rate of postoperative sternal infection is 0.9%-20%, but the associated mortality rate is high, ranging from 0% to 52%. 5 Wound infection is closely related to the environment of the operating room. The ventilation system, 6 the gowns worn by the surgical team, 7 and the level of conversation of the surgical team, 8 can all introduce so-called exogenous pathogens.…”

Tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia

“…The terms sternal osteomyelitis and mediastinitis have been mistakenly used as synonyms in an attempt to characterize deep sternal wound infection. (2,10) Until 1963, infections following sternotomy were usually treated with debridement and open wound, although complete healing sometimes took 6 months, and, in many cases, two or more subsequent debridements were necessary. (11) High rates of severe complications, such as hemorrhage of exposed mediastinal vessels, as well as high mortality rates (up to 45%), have been reported.…”