Effectiveness of therapeutic alternatives for the surgical solution of mediastinitis after a cardiac surgery

Abstract

Introduction: The longitudinal median sternotomy is a widely employed incision in cardiovascular surgery. The infections of the surgical wound are a serious health problem, but in this type of surgery, the deep infection, the postoperative mediastinitis, has high morbidity and mortality and it is a diagnostic and therapeutic challenge. Initially, surgical treatment protocols were open, but their evolution has stimulated the appearance of closed methods.

Objective: To assess the effectiveness of therapeutic alternatives for the surgical solution of mediastinitis after a cardiac surgery.

Method: A cross-sectional assessment study of health technology was conducted under application, with the information between the years 2000 and 2016, with its prior determination of indicators and its cutoffs.

Results: An incidence of 1.54% of postoperative mediastinitis was found. Being 40.9% of patients treated with open methods and 59.1% with closed, by the use of irrigation to the mediastinum with dilute povidone iodine. The application of the open method had an effectiveness of 57.1%, evaluated by seven predetermined indicators, and the closed method presented a complete effect (100%), after the evaluation of nine indicators.

Conclusions: The postoperative mediastinitis has a similar incidence of that in other centers. It has been treated with open and closed methods. The closed technique was more utilized and it achieved excellent therapeutic effectiveness, superior to the open one.