Key result
A multidisciplinary co-management care model reduced overall mortality compared to standard care in patients with post-sternotomy mediastinitis (11.1% vs 60.3%; HR 0.11; 95% CI 0.01-0.83).
Why the study?
Post-sternotomy mediastinitis is a feared complication of cardiac surgery, but the impact of a multidisciplinary management approach on it was unknown.
Does a multidisciplinary co-management model reduce mortality and treatment failure in patients with post-sternotomy mediastinitis compared to standard care?
Cohort (n=91)
Does a multidisciplinary co-management model reduce mortality and treatment failure in patients with post-sternotomy mediastinitis compared to standard care?
A multidisciplinary co-management model involving hospitalists significantly reduces mortality and treatment failure in patients with post-sternotomy mediastinitis.
Co-management was associated with lower PSM mortality; supports multidisciplinary models but leaves open need for prospective trials.
Background: Post-sternotomy mediastinitis (PSM) is one of the most feared complications of cardiac surgery. The impact of a multidisciplinary management approach on this pathology is yet unknown. Patients and Methods: A multidisciplinary approach based on a co-management model (CMM) of care was initiated in January 2018 because of the incorporation of a hospitalist unit on a cardiac surgery department. An observational retrospective cohort study was designed to evaluate the impact of the CMM of care compared to the standard model (SM) of care in patients diagnosed with PSM. Our primary and secondary outcomes were survival time and treatment failure rate (two or more surgical procedures needed to solve PSM or PSM-related death), respectively. Data related to patient death date were collected from the Spanish National Death Index. A multivariable Cox regression model was created using those variables believed to be clinically relevant. Results: Ninety-one patients developed PSM from January 2010 to June 2020. Regarding the pre-operative clinical status, surgical procedure, and PSM severity, both groups had similar baseline characteristics. Patients were followed for a mean of 27.54 ± 30.5 months. A total of 60.3% of the SM group and 11.1% of the CMM group (p < 0.001) died. Treatment failure occurred in 53 patients (72.6%) in the SM group versus 7 (38.6%) in the CMM group (p = 0.007). The CMM independently reduced overall mortality (hazard ratio [HR], 0.11; 95% confidence interval [CI]. 0.01–0.83) and treatment failure rate (HR, 0.01; 95% CI, 0.001–0.183). Gram-positive bacterial infection (HR, 3.73; 95% CI, .6–8.3), and complete osteosynthesis material removal (HR, 0.47; 95% CI, 0.24–0.91) also influenced mortality in our model. Conclusions: A co-management care model reduced overall mortality in patients diagnosed with post-sternotomy mediastinitis.
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Fernández et al. (2022) conducted a cohort in Post-sternotomy mediastinitis (n=91). Co-management model (CMM) of care vs. Standard model (SM) of care was evaluated on Survival time (overall mortality) (HR 0.11, 95% CI 0.01-0.83, p=<0.001). A multidisciplinary co-management care model reduced overall mortality compared to standard care in patients with post-sternotomy mediastinitis (11.1% vs 60.3%; HR 0.11; 95% CI 0.01-0.83).
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