Discriminate use of electrocautery on the median sternotomy incision. A 0.16% wound infection rate.
Between June 1978 and June 1989, superficial or deep mediastinitis (or both) developed in only five (0.16%) of 3118 consecutive patients. All patients studied underwent cardiac procedures through a median sternotomy and survived more than 7 postoperative days. The surgical team disciplined itself to divide presternal soft tissues with a scalpel and used electrocautery for pinpoint hemostasis only. This 0.16% infection rate was statistically significantly lower than those in 28 previously published studies (Pearson's chi 2 test, p less than 0.05). Twenty-four predisposing factors were evaluated by Fisher's exact test. Among these only an operating time longer than 3 hours is related to sternotomy infections (p = 0.0208), and this effect was not a strong one. Statistical evidence strongly suggests that discriminate use of electrocautery is a major reason for the lowest median sternotomy infection rate reported to date.
Nishida
H
H
Department of Surgery, Iowa Methodist Medical Center, Des Moines.
Grooters
R K
RK
Soltanzadeh
H
H
Thieman
K C
KC
Schneider
R F
RF
Kim
W P
WP
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control