Postoperative Wound Complications in Cardiac Surgery: What Exactly Are We Reporting (or Not Reporting)?

Background: The incidence of wound complications following cardiosurgical procedures requiring median sternotomy in the literature is between less than 1% and 7%. Often, the term “mediastinitis” is used to describe this complication. Before the advent of cardiac surgery, the term “mediastinitis” referred to inflammation or infection of the mediastinal space, frequently due to perforation of the esophagus. Other causes include odontogenic or retropharyngeal abscesses or infection. Today, the term “mediastinitis” is used to characterize a number of conditions we consider separate entities, including superficial, presternal, sternal and deep retrosternal wound healing disturbances, all of which may or may not show signs of bacterial infection. The latest S3 management guidelines now under development make some effort to discriminate these wound complications yet they still collectively suffer from the misnomer “mediastinitis.” Quality assurance data in Germany would suggest that many centers never experience this complication. The reasons for underreporting are complex and do not necessarily reflect the presence of intent or ulterior motives. Whether this problem is actively concealed or passively tolerated, successful measures for prevention, recognition and treatment cannot be put in place without accurate, well-differentiated data.

Methods: For this analysis, the German cardiosurgical quality assurance database was studied and the results were compared with available literature. The S3 guidelines currently under development were also taken into account. Data from health insurance companies and vacuum wound treatment system manufactures were also obtained.

Results: Our analysis leads us to suspect a significant discrepancy between the reported incidence of sternal wound problems and the amount of resources being used to treat sternal complications. The annual cost of treatment at a national level likely runs in the millions of Euros.

Conclusion: The definition of “mediastinitis” as it refers to wound complications following sternotomy must be revisited to avoid collecting a hodgepodge of separate entities under one misleading banner. Quality assurance reporting systems should be adapted to reflect this differentiation. The 30-day follow-up query should also be used to obtain wound complication data. These efforts should culminate in the development of superior prevention and treatment strategies.