Mediastinitis in cardiac surgery - patient insurance reports

Ugeskr Læger 2008;170(22):1905-1908

Introduction: Mediastinitis in cardiac surgery is a well-known complication associated with high morbidity, invalidity, and mortality. Since the establishment by law of patients insurance in Denmark 1992, it has been possible to get compensation in some instances.

Material and methods: During a period of 8 years (1996-2003) 30 cases of mediastinitis were reported to the Danish Patient Insurance Association (DPIA). The initial cardiac operations consisted of 28 coronary artery bypass graft operations (CABG), 1 CABG associated with substitution of the aortic valve, and 1 CABG with cryoablation because of atrial fibrillation. The median preoperative mortality risk (EuroSCORE) was 2 (0-6+). The treatment of mediastinitis consisted of open revision or closed rinsing-system and of vacuum assisted closure (VAC) in the later part of the period.

Results: Eighty percent of the patients had a transposition of thoracic muscle undertaken as a compensation for the lack of sternum. The median number of universal anaesthesias was 23 (3-32). The median admission time was 73 days (21-180), hospital mortality was 6.7%. A patient may receive compensation for an injury sustained during treatment if: 1) the best specialist would have acted differently, 2) the injury was caused by defect or malfunction of equipment, 3) the injury could have been prevented by using a different similar method of treatment, or 4) the patient had suffered more than is acceptable given the severity of the disease. Seventeen claims were approved (57%), the remainders were rejected. The criteria for acceptance according to the law of patient insurance are presented. In the actual period 511 cases of deep sternal infection after cardiac surgery were reported to the Danish Patient Registry.

Conclusion: The majority of mediastinitis cases were not reported to the DPIA. The parties involved (patients, patient advisors, general practitioners, and hospital departments) are asked to concentrate on the need of reporting these cases to the DPIA.