Risk factors for 1-year mortality after postoperative mediastinitis.

Published

Journal Article

OBJECTIVE: Postoperative mediastinitis after median sternotomy is associated with disability and mortality. The aim of this study was to identify risk factors for mortality 1 year after postoperative mediastinitis diagnosis. METHODS: Postoperative mediastinitis was defined as an organ-space infection involving the mediastinum and necessitating debridement. A total of 183 cases of postoperative mediastinitis were prospectively identified from infection control databases. By using univariate and multivariate analysis, clinical risk factors for 1-year mortality were identified. RESULTS: Of 183 patients, 36 (19.7%) died within 3 months of the initial operation. Overall, 51 (33%) died during the study period (the median time to death from the date of diagnosis was 37 days [interquartile range, 11,139 days]). In multivariate analysis, independent predictors of 1-year mortality were a greater than 3-day delay in sternal closure after debridement (hazard ratio, 6.27; P < .001), age greater than 65 years (hazard ratio, 2.29; P = .015), serum creatinine level greater than 2 mg/dL before debridement (hazard ratio, 2.52; P = .019), stay in an intensive care unit before sternal debridement (hazard ratio, 5.56; P < .001), and postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus (hazard ratio, 2.13; P = .02). Treatment with antibiotics with in vitro activity against the infecting pathogen within 7 days of initial debridement was associated with a decreased risk for mortality (hazard ratio, 0.40; P = .03). CONCLUSIONS: Our data suggest that, to improve long-term survival, patients with postoperative mediastinitis should undergo sternal closure within 72 hours after sternal debridement and should receive effective antimicrobial therapy based on operative culture results.

Full Text

Duke Authors

Cited Authors

  • Karra, R; McDermott, L; Connelly, S; Smith, P; Sexton, DJ; Kaye, KS

Published Date

  • September 2006

Published In

Volume / Issue

  • 132 / 3

Start / End Page

  • 537 - 543

PubMed ID

  • 16935107

Pubmed Central ID

  • 16935107

Electronic International Standard Serial Number (EISSN)

  • 1097-685X

Digital Object Identifier (DOI)

  • 10.1016/j.jtcvs.2006.04.037

Language

  • eng

Conference Location

  • United States