[HSF] post op mediastinitis discussion

[Douville, Chuck]

This discussion is relevant to our cardiac surgery colleagues around the world, although it is a financial issue only in the USA. CMS (center for medicare services), the agency responsible for medicare healthcare funding in the US recently announced it would no longer pay hospitals for costs due to postoperative mediastinitis in cardiac surgery patients effective within the next year. Despite perfect glucose control, antibiotic timing etc, my own recent morbidly obese re-do AVR pt had his chest open 7 hours due to difficult adhesions. S. epi wound infection on day 6 required opening his sternum, VAC therapy and IV antibiotics and an extra week in the hospital. The only way to avoid the infection in this pt that I can think of is to deny the operation to a 60 yr old man with critical AS after previous CABG 6 years earlier.  I do not believe the incidence of this problem can ever be zero. Thoughts?