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Cardiothoracic surgery

Introduction

Clinical overview

In a recent Editorial published in Medical Microbiology & Diagnosis, Dohmen (2013)1 reviews some of the clinical evidence surrounding Surgical Site Infections (SSI) in Cardiac surgery.  Superficial and deep post-sternotomy infections after cardiac sugery remains an important cause of morbidity and mortality, described in the literature with an incidence up to 15%.1

As both transient and residential skin flora will play different roles in superficial and deep post-sternotomy infections (Staphyloccocus Aureus, part of transient skin flora is seen more often in deep infection while Coagulase-negative staphylococci is most likely to be involved in superficial infection)2, it has been recognised that appropriate disinfecting strategies must be considered to manage transient and residential skin flora.1

As surgical case loads are progressively more complex and high-risk patients are increasingly common, it's more critical than ever to protect against post-operative complications.

Economic overview

"There is an economic burden associated associated with SSI, especially in patients suffering from post sternotomy medistinitis after cardiac surgery.  The literature normally only reports only on hospital costs due to prolonged hospitalization and re-admission.  Generally, the prolonged hospital stay of patients suffering from SSI is 10 days, in cardiac surgery even 12 days, which results in extra costs estimated to be around 19 billions Euros each year in Europe."1,3

As mentioned by Dohmen (2013)1, the hospital cost due to additional hospitalisation days to treat SSI is only a limited part apart of the direct health costs of patients treated with SSI.  The most important part of the economic burden due to SSI are the indirect costs due to temporary or permanent incapacity to work, expressed in years of productive life lost, morbidity, mortality, income lost by family members, forgone leisure time, travel costs, home care costs.1

Alfonso et al.4 have been investigating both the direct and indirect costs of surgical site infection in Spain.  It was shown that indirect costs related to SSI exceeded direct costs by about 8 times when taking into account years of productive life lost (total of 106 patients of which 74 were over 60 and 8 below the age of 40). 1,4

References

  1. Dohmen PM (2013) Economic Burden of Surgical Site Infections in Cardiac Surgery, J Med Microb Diagn, 2:3.
  2. Sharma M, Berriel-Cass D, Baran J Jr (2004) Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42-month period. Infect Control Hosp Epidemiol 25: 468-471.
  3. Dohmen PM (2008) Antiobiotic resistance in common pathogens reinforces the need to minimize surgical site infections. J Josp Infect 70: 15-20.
  4. Alfonso JL, Pereperez SB, Canoves JM, Martinez MM, et al. (2007) Are we really seeing the total costs of surgical site infections? A Spanish study. Wound Repair Regen 15: 474-481.

PICO can help

Improving outcomes with incisional NPWT

Negative Pressure Wound Therapy (NPWT) has a mechanism of action that improves the speed, strength and quality of incisional wound healing, thus minimising the failures of healing that lead to infection and/or dehiscence.

PICO Incision MOA

Considerable evidence shows NPWT delivers clinical benefits as part of effective incision management.1

Introducing PICO

PICO is a novel, canister- free, single-use system offering the ultimate in portable, accessible and affordable NPWT.

PICO Delivers Active Therapy

 

NPWT can help you manage your high risk patients

References

  1. Karlakki S et al, Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery, Bone Joint Res 2013; 2:276-84.

Recommended Pathway and Clinical Cases

Stannard et al (2009)1 proposed a grading system based on existing knowledge of risk factors for infection and dehiscence, seroma and hematoma.

  • Grade 1 – No risk factors
  • Grade 2 – Single risk factor
  • Grade 3 – Multiple risk factors

Known risk factors are diabetes, obesity, smoker, hypertension etc.

Results suggest that at-risk patients may benefit from NPWT immediately post-op; click here to see our Risk Identification pathway, which can help determine at-risk patients.

Click here to see a Cardiothoracic case study

References

  1. Stannard JP et al.  Use of negative pressure therapy on closed surgical incisions: a case series.  Ostomy Wound Manage. 2009 Aug 1;55(8):58-66.

Economic Benefits

Up to 1 in 10 patients with suffer with an SSI or complication following cardio surgery

Prevention of complications is cheaper than the cure

23 Bed Days

Cardiac surgery
SSI = Additional 23 days in hospital1 

In Hip replacement an SSI can doublethe cost of surgery

In Cardiac surgery, an SSI can double
the cost of surgery1

References

  1. Jenks et al. (2014), Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital.  Journal of Hospital Infection; 86. 24-33.

PICO Video

This video shows how PICO aids wound healing on incisions, and how its mode of action compares to a standard dressing.

Patients

Smith & Nephew is providing information in this site for general educational use only, and does not intend for this to be construed as medical advice or used as a substitute for the advice of your physician. For questions or concerns about a previous or upcoming surgery, Smith & Nephew recommends that you contact your healthcare professional.