Is mediastinitis a preventable complication? A 10-year review.

Area of Science:

• Cardiovascular Surgery
• Infectious Disease Epidemiology
• Surgical Outcomes Research

Background:

• Mediastinitis is a serious complication following cardiac surgery, with reported incidences ranging from 0.15% to 5%.
• Numerous risk factors for mediastinitis have been identified, but many are not amenable to modification.
• Effective operative technique and postoperative management are crucial for minimizing this complication.

Purpose of the Study:

• To evaluate the incidence of mediastinitis in a large cohort of cardiac surgery patients.
• To identify significant risk factors associated with mediastinitis.
• To assess the impact of surgical technique on mediastinitis rates.

Main Methods:

• A retrospective review of 9,771 cardiac surgical procedures performed between 1987 and 1997.
• Standardized protocols for skin preparation, draping, and antibiotic prophylaxis were applied.
• Mediastinitis cases were identified using multiple data sources and analyzed for risk factors.

Main Results:

• The incidence of deep sternal wound infection (mediastinitis) was 0.25%, with a mortality rate of 8.3%.
• Chronic obstructive pulmonary disease was the only significant risk factor identified (p < 0.01).
• Factors such as diabetes, smoking, obesity, and steroid use were not significant predictors.

Conclusions:

• A low incidence of mediastinitis (0.25%) and reoperation (0.19%) was observed in this large patient series.
• Except for bone wax and bilateral mammary arteries in diabetic patients, identified risk factors are largely non-modifiable.
• Strict adherence to perioperative aseptic technique, hemostasis, and sternal closure can achieve very low mediastinitis rates.