[HSF] post op mediastinitis discussion

[Ben Bidstrup]

>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?
>_______________________________________________

Well, the best way would be to use the NNECVSG risk tool for DSWI and 
exclude from surgery any patients with a greater than 2% risk. This 
is double the incidence mist units would see. Then tell them why, and 
let them discuss with their senator or congressman.

Tough measure need tough solutions!

Or call it something else.
-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon