Multi-Disciplinary and Protocol-Driven Post-Operative Care Reduces Incidence of Post-Sternotomy Mediastinitis

Post-sternotomy mediastinitis (PSM) is a rare but life-threatening complication of cardiac surgical procedures. This study evaluated the impact of a structured multi-disciplinary post-discharge care bundle on PSM incidence.

A single-center, retrospective cohort study compared the incidence of PSM two years before and after implementation of a care bundle led by a multi-disciplinary team. The intervention included telephonic monitoring, a specialized wound-care clinic, and a standardized two-phase wound management protocol incorporating single-use negative pressure wound therapy. Outcomes were assessed using chi-square tests and logistic regression adjusted with propensity scores and inverse probability weighting. To rule out a temporal trend in newly identified wound infections, we performed a linear regression using bimonthly incident counts as the outcome.

A total of 1,197 patients underwent median sternotomy between May 1, 2018, and April 30, 2022. The crude incidence of PSM was 3.32% in the pre-implementation group and 1.56% in the post-implementation group (p = 0.058). After adjustment with inverse probability of treatment weighting, the care bundle was associated with a significant reduction in PSM rate (absolute risk difference 1.96%, 95% confidence interval [CI]: 0.54-3.87; p = 0.044; relative reduction 59%, 95% CI: 16.3%-116%), despite a higher baseline surgical risk in the post-implementation cohort (higher EuroSCORE II, more urgent procedures, greater need for vasoactive support). The rate of newly identified wound infections did not exhibit a significant time trend (β = -0.43; p = 0.299).

Implementation of a multi-disciplinary care bundle is significantly associated with a reduction in PSM incidence in cardiac sternotomy patients, underscoring the importance of structured outpatient wound surveillance.