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Ann Thorac Surg 1992;53:301-305
© 1992 The Society of Thoracic Surgeons

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Articles

Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations

Division of Cardiothoracic Surgery, Department of Surgery, The New York Hospital-Cornell University Medical College, New York, New York, USA

Accepted for publication August 14, 1991.

^_* Address reprint requests to Dr Ko, Division of Cardiothoracic Surgery, The New York Hospital, Cornell University Medical College, 525 East 68th St, Box 378, New York, NY 10021.

To investigate the effects of the hair removal methods and intraoperative irrigation on suppurative mediastinitis after cardiopulmonary bypass operations, 1,980 consecutive adult patients over a 2-year period in our institution were prospectively randomized to manual shaving versus electrical clipping of hair before the skin incision, and to povidone-iodine solution (0.5%) versus saline solution mediastinal and subcutaneous irrigation before wound closure. The overall incidence of suppurative mediastinitis was 0.86% (17/1,980). The infectious rate was significantly higher in the manually shaven (13/990) than in the electrically clipped patients (4/990) with an odds ratio of 3.25 (95% confidence interval, 1.11 to 9.32; p = 0.024). It was also higher in the povidone-iodine group (11/990) than in the saline group (6/990), although the difference vas not statistically significant (p = 0.16). Fourteen patients were treated with operative debridement with closed tube irrigation, with one failure requiring a conversion to an open wound. Two patients were successfully treated with primary open wound procedures followed by delayed muscular flap closures, and 1 patient succumbed to rapid and profound sepsis soon after open drainage. We conclude that electrical clipping is superior to manual shaving in the prevention of suppurative mediastinitis. The routine use of povidone-iodine (0.5%) irrigation was of no benefit in this study and may increase the incidence of infection due to its known suppressive effects on local leukocytes and fibroblasts. Furthermore, operative debridement with closed tube irrigation was successful in treating the majority of cases in this series.

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