Conceptual maps for decisión-making in postoperative mediastinitis
Keywords:
Postoperative mediastinitis, Cardiovascular surgery, Surgical site infection, median sternotomyAbstract
Introduction: When it comes to human health, the offer of quality services and work based on patient safety are increasingly demanded. Modernity demands rapid decision-making in any situation, which is facilitated with action guides that include prediction, diagnosis, prevention, treatment and quality control. These are represented in wide-ranging algorithms such as conceptual maps. Objectives: To represent in conceptual maps a previously developed guide for the prediction, diagnosis, prevention and control of postoperative mediastinitis. Method: A retrospective analytical study of cases and controls was carried out with bivariate and then multivariate analysis for the construction of a prognostic scale, as well as probable diagnostic patterns and a systematic review using PRISMA methodology for the development of the guidelines, which were represented in conceptual maps by the cmaptool program. Results: For prediction, PREDICMED prognostic scale was the premise, built from the logistic regression model, with six predictors and their scores ranging from zero to thirteen, with two risk strata: not high and high. For the diagnosis, precede this guide, the four probable diagnostic patterns obtained by two-stage cluster analysis and the prevention and treatment actions for postoperative mediastinitis were developed, as well as checklists, then was all represented in conceptual maps. Conclusions: The action guides represented in conceptual maps facilitate the decision-making process in the face of mediastinitis after cardiovascular surgery.
Downloads
References
1. López D. Diseño y elaboración de mapas conceptuales para la toma de decisiones mul-ticriterio [tesis de grado]. [Sevilla]: Universi-dad de Sevilla; 2014. Disponible en: http://bibing.us.es/proyectos/abreproy/5413/fichero/MemoriaPFC.pdf
2. Maya-Lopera E. Los árboles de decisión como herramienta para el análisis de riesgos de los proyectos. Departamento administración y negocios [tesis de maestría]. [Colombia]: Universidad EAFIT; 2018. Disponible en: https://docplayer.es/110499309-Los-arboles-de-decision-como-herramienta-para-el-analisis-de-riesgos-de-los-proyectos-elena-maya-lopera.html
3. González R, Raffo M, Vera M, Alarcón E, Saldías R, Gyhra A, et al. Mediastinitis post-quirúrgica en cirugía cardíaca. Rev Chil Cir [Internet]. 2005 [citado 2025 jun. 25];57(3):[cerca de 5 pantallas]. Disponible en: http://www.cirujanosdechile.cl/revista_anteriores/PDF%20Cirujanos%202005_03/Cir.%203_2005-06.pdf
4. Barthelemy A. Post-sternotomy mediastinitis. En: Mathieu D, editor. Handbook on hyper-baric medicine [Internet]. Netherlands: Springer; 2006 [citado 2025 jun. 23]. p. 567-76. Disponible en: https://www.springer.com/gp/book/9781402043765#
5. van Wingerden JJ, Ubbink DT, van der Horst Ch MAM, de Mol BAJM. Poststernotomy medi-astinitis: a classification to initiate and evalu-ate reconstructive management based on ev-idence from a structured review. J Cardiotho-rac Surg [Internet]. 2014 [citado 2025 jun. 23];9(1):[cerca de 10 pantallas]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247689/pdf/13019_2014_Article_179.pdf
6. Ljungquist U. Wound sepsis after clean oper-ations. Lancet [Internet] 1964;1(7342):1095‐97.
7. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site Infections, 1992: a modification of CDC definitions of surgical wound infec-tions. Infect Control Hosp Epidemiol [Inter-net].1992 [citado 2025 jul. 19];13(10):[cerca de 3 pantallas]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/1334988/
8. Nieto M. Diseño y validación de un modelo predictivo de mediastinitis en cirugía cardiaca [tesis doctoral]: [Madrid]: Universidad Com-plutense de Madrid; 2014. Disponible en: https://dialnet.unirioja.es/servlet/tesis?codigo=98908
9. Machin JC Factores predictores de mediastini-tis aguda en cirugía cardiovascular, protocolo de prevención y algoritmos diagnóstico y te-rapéutico [tesis doctoral]. [Santiago de Cu-ba]: Universidad de Ciencias Médicas Santia-go de Cuba; 2011. Disponible en: http://tesis.sld.cu/FileStorage/000196-0AD2-MACHIN.pdf
10. National HealthCare Safety Network. Surgical Site Infection Event (SSI). Atlanta: NHSN; 2025. Disponible en: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
11. Urrútia G, Bonfill X. La declaración prisma: un paso adelante en la mejora de las publicacio-nes de la revista española de salud pública. Rev Esp Salud Pública [Internet]. 2013 [cita-do 2025 jun. 23];87(2):[cerca de 4 panta-llas]. Disponible en: http://scielo.isciii.es/pdf/resp/v87n2/01_editorial.pdf
12. Moher D, Liberati A, Tetzlaff J, Altman D, Grupo PRISMA. Ítems de referencia para pu-blicar revisiones sistemáticas y metaanálisis: la Declaración PRISMA. Rev Esp Nutr Hum Diet [Internet]. 2014 [citado 2025 jun. 20];18(3):[cerca de 9 pantallas]. Disponible en: http://www.renhyd.org/index.php/renhyd/article/view/114
13. Moraga J, Cartes-Velásquez R. Pautas de chequeo, Parte II: Quorom y Prisma. Rev Chil Cir [internet]. 2015 [citado 2025 jun. 23];67(3):[cerca de 5 pantallas]. Disponible en: https://scielo.conicyt.cl/pdf/rchcir/v67n3/art15.pdf
14. Cañas AJ, Hill G, Carff R, Suri N, Lott J, Eskridge T, et al. CmapTools a knowledge modeling and sharing environment. En: Con-cept maps: theory, methodology, technology: proceedings of the first International Confer-ence on Concept Mapping [Internet]. España: Universidad Pública de Navarra = Nafarroako Unibertsitate Publikoa, Servicio de Publicacio-nes; 2004. p. 125-34. Disponible en: https://thomaseskridge.com/assets/pdf/Canas-2004.pdf
15. Bermúdez-Year GJ. To take decisions in post-operative mediastinitis. challenges and future considerations. EC CARDIOLOGY [Internet]. 2019 [citado 2025 jul. 20];6(12):1-4.Disponible en: https://ecronicon.net/assets/eccy/pdf/ECCY-06-00443.pdf
16. Bermúdez-Yera GJ, Barreto-Fiu EE, Chaljub-Bravo E, López-de la Cruz Y, Naranjo-Ugalde A, Rabassa-López-Calleja MA, et al. Diseño y validación de la escala pronóstica cubana PREDICMED para estratificar el riesgo de mediastinitis postoperatoria. CorSalud [Inter-net]. 2020 [citado 2025 jul. 20];12(4):392-401. Disponible en: http://scielo.sld.cu/pdf/cs/v12n4/2078-7170-cs-12-04-392.pdf
17. Bermúdez-Yera GJ, Lagomasino-Hidalgo A, Naranjo-Ugalde A, Chaljub-Bravo E, González O., López-de la Cruz Y. Vulnerable Sternum. A new concept to propose some elements re-lated with postoperative mediastinitis risk. EC Cardiology [Internet]. 2020 [citado 2025 jul. 20];SI(02):[cerca de 4 pantallas]. Disponible en: https://www.ecronicon.com/eccy/si/ECCY-02-SI-0006.pdf
18. Bermúdez-Yera GJ, Lagomasino-Hidalgo A, Naranjo-Ugalde A, Rabassa- López-Calleja MA. Reconstrucción ósea con neoesternón a partir de tejidos adyacentes a la herida qui-rúrgica. CorSalud [Internet]. 2019 [citado 2025 jul. 20];11(3):243-4. Disponible en: http://www.revcorsalud.sld.cu/index.php/cors/article/view/492/918)
19. Bermúdez-Yera GJ, Lagomasino-Hidalgo A, Naranjo-Ugalde A., Chaljub-Bravo E. Autolo-gous bilogical neosternum. A surgical alterna-tive to third intention closure in patients with loss of the sternum after postoperative me-diastinitis or osteomyelitis. EC CARDIOLOGY [Internet]. 2019 [citado 2025 jul. 20];6(9):[cerca de 6 pantallas]. Disponible en: https://www.ecronicon.com/eccy/pdf/ECCY-06-00383.pdf
20. Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, et al. European Association for Cardio-Thoracic Surgery ex-pert consensus statement on the prevention and management of mediastinitis. Eur J Car-diothorac Surg [Internet]. 2017 [citado 2025 jun. 23];51(1):[cerca de 19 pantallas]. Dis-ponible en: https://pubmed.ncbi.nlm.nih.gov/28077503/
21. Goh-Siew SC. Post-sternotomy mediastinitis in the modern era. J Card Surg [Internet]. 2017 [citado 2025 jul. 20];32(9):[cerca de 10 pantallas]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28833518/
22. Lazar H L, Vander-Salm T, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. Expert Consensus Review: perioperative management. J Thorac Cardiovasc Surg [Internet]. 2016 [citado 2025 jul. 20];152:[cerca de 10 pantallas]. Disponible en: https://www.jtcvs.org/article/S0022-5223(16)30872-8/pdf
23. Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Up-date. J Am Coll Surg [Internet]. 2016 [citado 2025 jun. 23];224(1):[cerca de 5 panta-llas].Disponible en: https://pubmed.ncbi.nlm.nih.gov/27915053/
24. Ling ML, Apisarnthanarak A, Abbas A, Mori-kane K, Lee KL, Warrier A, et al. APSIC guidelines for the prevention of surgical site infections. Antimicrob Resist Infect Control [Internet]. 2019 [citado 2025 jun. 23];8(174).[cerca de 5 pantallas].Disponible en: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0638-8
25. World Health Organization. Global guidelines for the prevention of surgical site infection [Internet]. 2a ed. Geneva: WHO; 2018 [citado 2025 jun. 23]. Disponible en: https://apps.who.int/iris/handle/10665/277399?utm_medium=email&utm_source=transaction
26. Sajja LR. Strategies to reduce deep sternal wound infection after bilateral internal mam-mary artery grafting. Int J Surg [internet]. 2015 [citado 2025 jun. 23];16(pt B):[cerca de 9 pantallas].Disponible en: https://pubmed.ncbi.nlm.nih.gov/25463763/
27. Crawford TC, Zhou X, Fraser CD, Magruder T, Suarez-Pierre A, Alejo D, et al. Bilateral in-ternal mammary artery use in diabetic pa-tients: friend or foe? Ann Thorac Surg [In-ternet]. 2018 [citado 2025 jun. 23];106(4):1088-1094. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29758209/
28. Bermúdez-Yera GJ, Lagomasino-Hidalgo AA, Navas-Contino M. Efectividad de las alternati-vas terapéuticas para la solución quirúrgica de las mediastinitis después de una cirugía cardíaca. CorSalud [Internet]. 2017 [citado 2025 jun. 23];9(2):[cerca de 8 pantallas]. Disponible en: http://scielo.sld.cu/pdf/cs/v9n2/cs04217.pdf
29. Andersen BM. Prevention of postoperative wound infections [Internet]. Cham: Springer International Publishing; 2019 [citado 2025 jun. 23]. Prevention and control of infections in hospitals; p. 377-437. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC7122543/pdf/978-3-319-99921-0_Chapter_33.pdf
30. Zukowska A, Zukowski M. Surgical site infec-tion in cardiac surgery. J Clin Med [Internet]. 2022 [citado 2025 jun. 23];11(23):6991. Dis-ponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9738257/pdf/jcm-11-06991.pdf
31. Rogers LJ, Vaja R, Bleetman D, Ali JM, Rochon M, Sanders J, et al. Interventions to prevent surgical site infection in adults un-dergoing cardiac surgery. Cochrane Database Sys Rev [Internet]. 2019 [citado 2025 jun. 23];2019(5):CD013332. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6520030/pdf/CD013332.pdf
32. Hariri G, Kwok W, Villaamil A, Demondion P, Bouglé A. Mediastinitis tras cirugía cardíaca. EMC Anestesia-Reanimación [Internet]. 2024 [citado 2025 jun. 23];50(1):1-8. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1280470323486628?via%3Dihub
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Gustavo de J. Bermúdez Yera
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
