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Post‐sternotomy mediastinitis in the modern era
Author(s) -
Goh Siew S.C.
Publication year - 2017
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13189
Subject(s) - mediastinitis , medicine , perioperative , surgery , cardiac surgery , complication , antibiotic prophylaxis , median sternotomy , incidence (geometry) , general surgery , intensive care medicine , antibiotics , physics , optics , microbiology and biotechnology , biology
Background Post‐sternotomy mediastinitis is associated with significant mortality and morbidity. Despite surgical advances in cardiac surgery and improvements in perioperative care, mediastinitis remains a devastating post‐operative complication. This study provides a comprehension review of post‐sternotomy mediastinitis in the modern era, and discusses the incidence, risk factors, microbiology, prevention, and management of this complication. Methods This review was based on a PubMed/MEDLINE literature search up until 9th March 2017 for publications relevant to mediastinitis post‐cardiac surgery. Results The incidence of mediastinitis post‐cardiac surgery varies between 0.3 and 3.4%, and is associated with an in‐hospital mortality ranging from from 1.1 to 19%. The risk of developing post‐operative mediastinitis is dependent on the patients' co‐morbidities (diabetes, obesity, smoking, renal failure) and surgical techniques (bilateral pedicled internal mammary harvest, excessive cautery, long duration of surgery). Preventative measures including skin and nasal decontamination, antibiotic prophylaxis, strict glycemic control, and meticulous surgical techniques are crucial in reducing the risk. Treatment of post‐operative mediastinitis include culture‐directed antibiotic therapy, early wound exploration, and debridement followed by sternal reconstruction/closure. Vacuum‐assisted therapy can be used as a single line therapy or as a bridge to eventual sternal reconstruction/closure. Conclusion Post‐sternotomy mediastinitis remains a potentially fatal complication of cardiac surgery despite the advancements in the perioperative care in the modern era. Management on preventative measures, prompt diagnosis, and managements are crucial in reducing associated mortality and morbidity.