Deep sternal wound infection: the role of early debridement surgery

Objective: This retrospective chart review study aimed to evaluate whether a more aggressive staged approach can reduce morbility and mortality follow ing postcardiotomy deep sternal wound infection. Methods: Between 1979 and 2000, 14620 patients underwent open heart surgery: mediastinitis developed in 124 patients (0.85%). Patients were divided in two groups: in 62 patient s (Group A) (1979-1994) an initial attempt of conservative antibiotic thera py was the rule followed by surgical approach in case of failure; in 62 pat ients (Group B) ( 1995-2000) the treatment was staged in three phases: (1) wound debridment, removal of wires and sutures, closed irrigation for 10 da ys, (2) in case of failure open dressing with sugar and hyperbaric therapy (11 patients, 17%); (3) delayed healing and negative wound cultures mandate d plastic reconstruction (three patients, 4%). Categorical values were comp ared using the Chi-square test, continuous data were compared bq unpaired t -test. results: Incidence of mediastinitis was higher in Group B (62 out of 5535; 1.3%) than in Group A (62 out of 9085; 0.7%:) (P = 0.007). Mean inte rval between diagnosis and treatment was shorter in Group B (18 +/- 6 days) than in group A (38 +/- 7 days) (P = 0.001). Hospital mortality was higher in Group A (19/62; 31%) than in Group B (1 out of 62; 1.6%) (P < 0.001). H ospital stay was shorter in Group B (30.5 <plus/minus> 3 days) than in grou p A (44 +/- 9 days) (P = 0.001). In Group B complete healing was observed i n all the 61 survivors: 47 cases (76%) after Stage 1; 11 (18%) after Stage 2; three (4.8%) after Stage 3. Conclusions: Although partially biased by th e fact that the two compared groups draw back to different decades, this st udy showed that an aggressive therapeutic protocol can significantly reduce morbility and mortality of deep sternal wound infection. (C) 2001 Elsevier Science B.V. All rights reserved.