Mediastinitis tras cirugía cardíaca: estudio de casos y controles para detectar áreas de mejora

Abstract

Background Postoperative mediastinitis is one of the most serious complications of cardiac surgery. Several risk factors and strategies to reduce the incidence of this complication have been described. The aim of this study was to determine the incidence of and risk factors for mediastinitis in patients undergoing cardiac surgery in the Hospital Universitario La Paz in Madrid (Spain) and to make recommendations for improving the healthcare process. Material and methods We performed a case-control study, selecting two controls for each case of mediastinitis diagnosed in 2002, 2003, and the first four months of 2004. Information was gathered by reviewing medical records. Statistical analysis consisted of descriptive (mean, median, standard deviation and frequency distribution) and analytic techniques (Pearson's χ 2 test and the Mann-Whitney U test). Results The incidence of mediastinitis was 3.5%. The main factors identified as requiring improvement were glycemic control, a priori identification of at-risk patients –for which an index evaluating eight items was designed– and early intervention when two or more patients were diagnosed in one month. Conclusions Based on the results of this study, changes were proposed to the healthcare process that could help to reduce the incidence of mediastinitis in patients undergoing cardiac surgery in our hospital.