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Abstract
BackgroundMediastinitis is a rare, but serious complication of cardiac surgery. It has a significant socioeconomic impact and high morbidity. The purpose of this study was to determine pre-, intra-, and postoperative predictors of mediastinitis.Methods and resultsIn 1700 consecutive patients, who underwent cardiac surgery in 2001, 49 variables were retrospectively assessed. Forty-five patients (2.65%, 95% CI [1.88; 3.41]) developed postoperative mediastinitis. None of these patients died during their hospitalization. Multivariate analysis identified three of the 49 variables as highly significant independent predictors for the development of mediastinitis: obesity (OR 1.03, 95% CI [1.01; 1.04] p = 0.001), chronic obstructive pulmonary disease (OR 3.30, 95% CI [1.58; 6.88], p = 0.001), and bilateral grafting of the internal mammary artery (OR 3.18, 95% CI [1.20; 8.43] p = 0.02). The model is reliable in terms of its goodness of fit, it also discriminates well. Additionally, univariate analysis identified diabetes mellitus, CCS class and the number of intraoperatively transfused units of fresh frozen plasma as variables with a significant impact.ConclusionThe present study suggests that bilateral IMA grafting, chronic obstructive pulmonary disease and obesity are important predictors of mediastinitis.
Highlights
Mediastinitis is a rare, but serious complication of cardiac surgery
Some authors favor the intraoperative contamination [2], whereas other studies demonstrated that endogenous bacteria might be pathogenetically involved [3,4] because preoperative intranasal antibiotic treatment significantly reduced the incidence of mediastinitis
The mean postoperative length of stay was 43 ± 35 days for the mediastinitis group compared to 19 ± 17 days for patients without mediastinitis (p < 0.001)
Summary
Mediastinitis is a rare, but serious complication of cardiac surgery. It has a significant socioeconomic impact and high morbidity. The purpose of this study was to determine pre-, intra, and postoperative predictors of mediastinitis. As a severe complication of cardiac surgery, mediastinitis continues to be associated with tremendous morbidity and cost [1]. Several studies published during the last ten years reported an incidence of 0.4 to 5% [5,6] and in-hospital mortalities between 14 and 23%, even when mediastinitis was correctly treated [7,8,9]. Braxton et al compared in a 4-year follow-up study the survival rates of patients with and without mediastinitis after cardiac operations. Eighty nine percent of patients survived in the non-mediastinitis group compared to 65% in the mediastinitis group after four years [10]
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