Abstract
BackgroundAs high-risk cardiac patients frequently remain within hospital while waiting for surgery, the aim of the present study was to determine the role of preoperative length of hospital stay on mediastinitis, and also, to assess contemporary risk factors for this complication.MethodsThe source population consisted of 6653 consecutive patients undergoing coronary bypass surgery, valve surgery, or both between September 2000 and September 2009 at a single tertiary care hospital. A retrospective cohort analysis was used to assess the effect of 18 preoperative variables, including length of stay, on mediastinitis.ResultsMediastinitis developed in 108 patients (1.6%) resulting in an in-hospital mortality rate of 13.9%. Independent predictors of mediastinitis included obesity (2.59, CI 1.58-4.23), COPD (2.44, CI 1.55-3.84), diabetes (2.16, CI 1.44-3.24), and impaired estimated glomerular filtration rate. Preoperative hospital stay was also found to be an independent risk factor leading to a 15% increased risk of mediastinitis per week of stay. The primary wound pathogen was coagulase negative staphylococcus (82%) followed by multi-flora isolates (49%), but was unrelated to hospital stay.ConclusionsIn addition to the traditional risk factors, prolonged preoperative hospital stay is also a significant and potentially modifiable predictor for the development of mediastinitis following cardiac surgery. All efforts should be made to minimize the delay in operating on hospitalized patients awaiting heart surgery.
Highlights
As high-risk cardiac patients frequently remain within hospital while waiting for surgery, the aim of the present study was to determine the role of preoperative length of hospital stay on mediastinitis, and to assess contemporary risk factors for this complication
Preoperative variables that were collected prospectively as part of a clinical registry maintained by the Division of Cardiac Surgery included the following: age, sex, obesity, ejection fraction, type of operation, smoking, diabetes mellitus, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF), preoperative creatinine, preoperative estimated glomerular filtration rate, congestive heart failure (CHF), hypertension, redo surgery, left main coronary disease, preoperative hospital length of stay, operative status, and Parsonnet score
Definitions Mediastinitis was defined according to the Center for Disease Control and Prevention criteria [14]; all suspected cases were confirmed by CT scan imaging of the chest
Summary
As high-risk cardiac patients frequently remain within hospital while waiting for surgery, the aim of the present study was to determine the role of preoperative length of hospital stay on mediastinitis, and to assess contemporary risk factors for this complication. Despite improved surgical techniques and preoperative antibiotic prophylaxis, surgical site infections, mediastinitis, remains a potentially fatal complication after open-heart surgery with an incidence of 0.6% - 2.65% [1,2,3,4,5]. The aim of the present study, was to identify preoperative risk factors for mediastinitis in current practice, and to assess the role of preoperative length of stay on deep sternal wound infection in the context of increasing surgical delays
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