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Mediastinitis and long-term survival after coronary artery bypass graft surgery
J H Braxton1, C A Marrin, P D McGrath
1Maine Medical Center, Portland, USA. jbraxto2@maine.rr.com
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Mediastinitis after coronary artery bypass grafting (CABG) significantly increases mortality. This study found a threefold higher risk of death in CABG patients who develop mediastinitis.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Complications
- Outcomes Research
Background:
- Mediastinitis is a serious complication following coronary artery bypass grafting (CABG).
- The long-term impact of mediastinitis on patient survival after CABG remains understudied.
Purpose of the Study:
- To investigate the association between mediastinitis and long-term mortality in patients who underwent isolated CABG.
- To quantify the survival impact of mediastinitis in the post-CABG population.
Main Methods:
- Analysis of survival data for 15,406 patients undergoing isolated CABG between 1992 and 1996.
- Linking patient records to the National Death Index for mortality tracking.
- Defining mediastinitis as an infection during the initial hospital stay requiring reoperation.
Main Results:
- Mediastinitis occurred in 1.25% of patients (193 cases).
- Patients with mediastinitis had higher rates of comorbidities and severe obesity.
- Multivariate analysis revealed a significantly lower first-year survival (78% vs. 95%) and a 3.09-fold increased mortality hazard ratio over the follow-up period.
Conclusions:
- Mediastinitis is strongly linked to increased mortality in the first year after CABG.
- A threefold increase in mortality risk is observed during a 4-year follow-up period for CABG patients who develop mediastinitis.
Background:
Mediastinitis is a dreaded complication of coronary artery bypass surgery (CABG). The long-term effect of mediastinitis on mortality after CABG has not been well studied.
Methods:
We examined the survival of 15,406 consecutive patients undergoing isolated CABG surgery from 1992 through 1996. Patient records were linked to the National Death Index. Mediastinitis was defined as occurring during the index admission and requiring reoperation.
Results:
Mediastinitis occurred in 193 patients (1.25%). Patients with mediastinitis were older and more likely to have had emergency surgery, diabetes, peripheral vascular disease, chronic obstructive pulmonary disease, and preoperative dialysis-dependent renal failure. Patients with mediastinitis were also more likely to be severely obese and had somewhat lower preoperative ejection fraction. After multivariate adjustment for these factors, the first year post-CABG survival rate was 78% with mediastinitis and 95% without, and the hazard ratio for mortality during the entire follow-up period was 3.09 (CI 95% 2.28, 4.19; p < 0.0001).
Conclusions:
Mediastinitis is associated with a marked increase in mortality during the first year post-CABG and a threefold increase during a 4-year follow-up period.