Surgical Versus Conservative Treatment of Post-Sternotomy Mediastinitis: Clinical Characteristics, Microbiology, and Outcomes from a 10-Year Cohort.

Background: Post-sternotomy mediastinitis (PSM) remains one of the most serious complications of cardiac surgery. This study aimed to evaluate the clinical features, management strategies, and outcomes of patients with PSM, comparing surgical and conservative treatment approaches. Methods: We retrospectively reviewed all cases of PSM (March 2014-July 2024) at our tertiary referral centre. Results: A total of 81 patients were included (39 surgically treated, 42 conservatively managed). The length of hospital stay was significantly longer in the surgical group (p = 0.003), and blood transfusions were more frequent (p = 0.005). Patients in the conservative group had higher DSW-STS risk scores (p = 0.014). Positive blood cultures were significantly more common among surgically treated patients (p < 0.001). The in-hospital mortality rate was 2.5% overall, with no difference between groups. Conclusions: These results likely reflect the greater clinical severity and complexity of patients selected for surgery, rather than an adverse effect of the procedure itself. Surgical treatment of PSM is associated with longer hospitalisation and greater need for blood transfusion, reflecting the higher clinical complexity of these cases. Nevertheless, outcomes in terms of survival were comparable to conservative management, supporting an individualised, multidisciplinary approach to optimise care for patients with post-sternotomy mediastinitis.