[HSF] post op mediastinitis discussion

[Michael Firstenberg]

.... obviously it must be someone else's fault.

On 10/3/07, Tea Acuff <tacuff at swbell.net> wrote:
>
> The only logical conclusion if infection is due to insufficient technique,
> is that you are an insufficient doctor. If I were you, I would blame my
> help.
>
> tea
>
>
> ----- Original Message ----
> From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wednesday, October 3, 2007 2:36:39 AM
> Subject: Re: [HSF] post op mediastinitis discussion
>
>
> >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
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