Surreal illustration of an open chest representing poststernotomy mediastinitis.

Decoding Poststernotomy Mediastinitis: Unmasking the Hidden Risks After Open Heart Surgery

Nico Varela in Health & Wellness December 2025 • 3 min read.

"Understanding the factors that increase the risk of poststernotomy mediastinitis and why some risks are harder to avoid."

Open-heart surgery, while life-saving, carries the risk of complications. One of the most serious is poststernotomy mediastinitis (PSM), a deep infection of the chest area that can lead to prolonged hospital stays, increased healthcare costs, and even death.

Recent research published in The Journal of Thoracic and Cardiovascular Surgery sheds light on the factors that increase the risk of PSM. This article delves into these findings, explaining what PSM is, why it's a concern, and what the research reveals about preventable and unavoidable risk factors.

This article aims to translate complex medical findings into accessible knowledge, empowering you to understand the risks associated with open-heart surgery and the ongoing efforts to minimize complications.

What are the Key Risk Factors for Poststernotomy Mediastinitis?

Surreal illustration of an open chest representing poststernotomy mediastinitis.

A detailed analysis of nearly 4,000 surgeries identified several key risk factors for PSM. These factors can be broadly categorized into preoperative (existing before surgery) and perioperative (occurring during surgery) variables.

The research identified four significant preoperative risk factors:

Age over 70 years: Older patients are generally more vulnerable to infections due to weakened immune systems.
Chronic Obstructive Pulmonary Disease (COPD): Lung conditions like COPD can impair the body's ability to fight off infection.
Obesity (BMI over 30 kg/m²): Obesity is associated with impaired immune function and increased risk of surgical site infections.
Use of Antiplatelet Therapy: Medications like aspirin or clopidogrel, which prevent blood clotting, can increase bleeding risks and potentially compromise the immune response.

Perioperative risk factors included ischemic duration over 60 minutes, emergency reoperation, and prolonged intubation (over 24 hours).

The Challenge of Modifying Risk Factors: What Can Be Done?

The study highlights a crucial point: some risk factors are more difficult to modify than others. While steps can be taken to manage blood sugar levels in diabetic patients or optimize a patient's overall health before surgery, factors like age or the necessity for emergency reoperation are often unavoidable.

The researchers emphasized the importance of identifying risk factors that can be modified. The use of antiplatelet agents before surgery was identified as a modifiable risk, suggesting that careful consideration should be given to discontinuing these medications when appropriate, balancing the risk of bleeding with the risk of infection.

Ultimately, understanding the complex interplay of risk factors is essential for optimizing patient care and minimizing the incidence of PSM. Further research is needed to explore new strategies for mitigating both modifiable and non-modifiable risks, leading to safer outcomes for patients undergoing open-heart surgery.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jtcvs.2017.10.008, Alternate LINK

Title: Poststernotomy Mediastinitis: Early Risk Factors Identified But Hard To Modify

Subject: Cardiology and Cardiovascular Medicine

Journal: The Journal of Thoracic and Cardiovascular Surgery

Publisher: Elsevier BV

Authors: Vincent Conti

Published: 2018-03-01

Everything You Need To Know

What is Poststernotomy Mediastinitis (PSM)?

Poststernotomy Mediastinitis (PSM) is a severe deep chest infection that can occur after open-heart surgery. It affects the mediastinum, the space in the chest that contains the heart, major blood vessels, and other vital structures. This infection is a significant concern due to its potential to cause extended hospital stays, higher healthcare expenses, and even death. PSM develops when bacteria invade the surgical site after open-heart surgery.

What are the primary risk factors for Poststernotomy Mediastinitis (PSM)?

Several factors can increase the risk of developing Poststernotomy Mediastinitis (PSM). The research identifies both preoperative and perioperative variables. Preoperative risk factors include: Age over 70, Chronic Obstructive Pulmonary Disease (COPD), Obesity (BMI over 30 kg/m²), and the Use of Antiplatelet Therapy. Perioperative risk factors include Ischemic duration over 60 minutes, emergency reoperation, and prolonged intubation (over 24 hours). These factors collectively increase the likelihood of infection and complications.

Are all risk factors for Poststernotomy Mediastinitis (PSM) easily modified?

Some risk factors for Poststernotomy Mediastinitis (PSM) are more challenging to change. For instance, age is a fixed factor, and emergency reoperations are often unavoidable in critical situations. While efforts can be made to manage conditions like diabetes or enhance a patient's overall health before surgery, certain factors remain beyond immediate control. Understanding which risks are modifiable helps in targeting preventative measures effectively.

Why is it important to understand the risk factors of Poststernotomy Mediastinitis (PSM)?

The significance of understanding the risk factors for Poststernotomy Mediastinitis (PSM) lies in the potential to improve patient outcomes and reduce complications following open-heart surgery. By identifying these risk factors, healthcare professionals can develop targeted strategies to prevent and manage infections. This proactive approach can lead to shorter hospital stays, lower healthcare costs, and ultimately, save lives. It emphasizes the importance of early detection and effective treatment protocols.

How can the risks associated with Poststernotomy Mediastinitis (PSM) be mitigated?

Modifying the risk factors associated with Poststernotomy Mediastinitis (PSM) involves a multi-faceted approach. For modifiable preoperative risks, strategies include optimizing patients' health before surgery, such as controlling blood sugar levels in diabetic patients and encouraging smoking cessation. Perioperative strategies include careful surgical techniques, strict infection control measures, and minimizing ischemic duration. For unavoidable risk factors, early detection through regular monitoring and prompt treatment are essential to mitigate the impact of the infection.