Characteristics and Predictors of Mortality in Descending Necrotizing Mediastinitis: A Retrospective Cohort Study

Abstract

Background: Descending necrotizing mediastinitis (DNM) is a life-threatening infection originating from necrotizing soft tissue infections, particularly in the cervical and oropharyngeal regions. DNM has a high mortality rate if not promptly diagnosed and treated surgically. Despite its severity, there is limited research on the characteristics and outcomes of DNM patients in Indonesia, especially in East Java. Methods: We conducted a single-center retrospective cohort study at Dr. Soetomo Hospital, Surabaya, Indonesia, analyzing the medical records of DNM patients treated between January 2021 and June 2023. Data on demographic, clinical, and surgical characteristics, along with treatment approaches, were collected. Statistical analyses included univariate and bivariate analyses to identify predictors of mortality. Results: Among 37 patients (mean age 45.6 years; 64.9% male), the primary infection source was odontogenic (86.5%). Most patients (51.4%) were classified as DNM type I, with cervicotomy and substernal drainage as the most common surgical approach (97.3%). The mean ICU stay was 6.6 days, and the overall hospital stay was 11.3 days. The mortality rate was 48.6%. Shorter hospital stays were significantly associated with increased mortality (p=0.000). Conclusion: DNM remains a severe condition with high mortality, primarily originating from odontogenic sources. Prompt diagnosis, appropriate surgical intervention, and targeted antibiotic therapy are critical to improving outcomes. Our study underscores the need for standardized management guidelines to enhance patient survival rates in regions with limited resources.