Our Summary

This research paper investigates the impact of a collaborative approach to treating patients with post-sternotomy mediastinitis (PSM), a dangerous complication that can occur after heart surgery. The authors compared a traditional care model with a newer, multidisciplinary approach that was implemented in 2018, thanks to the inclusion of a dedicated hospital care team within the cardiac surgery department.

They looked at 91 patients who developed PSM between 2010 and 2020, and compared the survival rates and treatment success in both care models. The findings showed that the newer, collaborative model of care significantly improved patient outcomes. Only 11.1% of patients in the collaborative care model died, compared to 60.3% in the traditional care model. Similarly, treatment failure was much lower in the collaborative model (38.6%) compared to the traditional model (72.6%).

The study also found that gram-positive bacterial infection and the complete removal of surgical materials influenced patient survival rates. In conclusion, the research suggests that a more collaborative approach to care can significantly improve survival rates for patients with post-surgery complications.

FAQs

  1. What is post-sternotomy mediastinitis (PSM)?
  2. How does the collaborative care model compare to the traditional care model in terms of patient survival rates?
  3. What factors were found to influence patient survival rates following PSM?

Doctor’s Tip

One helpful tip a doctor might give a patient about sternotomy is to carefully follow post-operative care instructions to reduce the risk of complications such as post-sternotomy mediastinitis. This can include proper wound care, avoiding strenuous activities, and attending follow-up appointments as scheduled. It is important to report any symptoms such as redness, swelling, or drainage from the incision site to your healthcare provider promptly. By following these guidelines, patients can help ensure a smooth recovery and reduce the likelihood of complications.

Suitable For

Patients who have undergone heart surgery and subsequently develop post-sternotomy mediastinitis (PSM) are typically recommended sternotomy. This is a procedure in which the chest is reopened in order to treat and manage the infection in the mediastinum, the area in the middle of the chest that contains the heart, major blood vessels, and other structures.

Sternotomy may be recommended for patients with PSM who have not responded to initial antibiotic treatment, or who have complications such as abscess formation or sternal dehiscence (separation of the sternum). Additionally, patients who have recurrent infections or who are at high risk for complications may also be recommended sternotomy in order to effectively treat the infection and prevent further complications.

Overall, sternotomy is recommended for patients with PSM who require surgical intervention to manage the infection and improve their outcomes. The collaborative approach to care described in the research paper may also play a role in determining the best course of treatment for these patients, as it allows for a multidisciplinary team to provide comprehensive and individualized care.

Timeline

Before sternotomy:

  1. Patient undergoes a thorough pre-operative assessment and evaluation by medical professionals to determine the need for heart surgery.
  2. Patient is informed about the risks and benefits of the procedure, and gives consent for the surgery.
  3. Patient undergoes the sternotomy procedure, where the chest is opened to access the heart for surgery.

After sternotomy:

  1. Patient is closely monitored in the intensive care unit (ICU) immediately following the surgery.
  2. Patient may experience pain, discomfort, and difficulty breathing due to the sternotomy incision.
  3. Patient undergoes post-operative care, including medication management, wound care, and physical therapy to aid in recovery.
  4. Patient may experience complications such as post-sternotomy mediastinitis (PSM), which can be life-threatening if not treated promptly.
  5. Patient may require additional surgeries, antibiotics, and ongoing medical care to manage and treat complications.
  6. Patient undergoes follow-up appointments and monitoring to assess recovery and overall health post-sternotomy.

What to Ask Your Doctor

  1. What is a sternotomy and why is it performed?
  2. What are the potential risks or complications associated with sternotomy?
  3. How common is post-sternotomy mediastinitis (PSM) and what are the symptoms?
  4. How is PSM diagnosed and what are the treatment options?
  5. What is the difference between a traditional care model and a collaborative care model for treating PSM?
  6. What are the advantages of a multidisciplinary approach to treating PSM?
  7. How does the inclusion of a dedicated hospital care team within the cardiac surgery department improve patient outcomes?
  8. What factors contribute to patient survival rates in the treatment of PSM?
  9. How can gram-positive bacterial infection and the complete removal of surgical materials impact patient outcomes?
  10. Based on the findings of this study, what recommendations do you have for patients undergoing sternotomy surgery to reduce the risk of complications such as PSM?

Reference

Authors: Fernández-de-Velasco D, Villamor-Jiménez C, Carnero-Alcázar M, Sánchez-Del-Hoyo R, Pérez-Camargo D, Montero-Cruces L, Torres-Maestro B, Giraldo MA, Reguillo-Lacruz FJ, Campelos-Fernández P, Villagrán-Medinilla E, Kisuule F, Calleja-Sanz J, Maroto-Castellanos L, Álvarez-de-Arcaya A. Journal: Surg Infect (Larchmt). 2022 Dec;23(10):873-879. doi: 10.1089/sur.2022.176. Epub 2022 Nov 7. PMID: 36346276