Pii: S1010-7940(01)00676-5

Objective: This retrospective chart review study aimed to evaluate whether a more aggressive staged approach can reduce morbility and mortality following post-cardiotomy deep sternal wound infection. Methods: Between 1979 and 2000, 14 620 patients underwent open heart surgery: mediastinitis developed in 124 patients (0.85%). Patients were divided in two groups: in 62 patients (Group A) (1979±1994) an initial attempt of conservative antibiotic therapy was the rule followed by surgical approach in case of failure; in 62 patients (Group B) (1995±2000) the treatment was staged in three phases: (1) wound debridment, removal of wires and sutures, closed irrigation for 10 days; (2) in case of failure open dressing with sugar and hyperbaric therapy (11 patients, 17%); (3) delayed healing and negative wound cultures mandated plastic reconstruction (three patients, 4%). Categorical values were compared using the Chi-square test, continuous data were compared by 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 ˆ 0:007). Mean interval between diagnosis and treatment was shorter in Group B (18 ^ 6 days) than in group A (38 ^ 7 days) (P ˆ 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). Hospital stay was shorter in Group B (30.5 ^ 3 days) than in group A (44 ^ 9 days) (P ˆ 0:001). In Group B complete healing was observed in 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 the fact that the two compared groups draw back to different decades, this study showed that an aggressive therapeutic protocol can signi®cantly reduce morbility and mortality of deep sternal wound infection. q 2001 Elsevier Science B.V. All rights reserved.