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A Prospective Multi-Institutional Cohort Study of Mediastinal Infections After Cardiac Operations.
Louis P Perrault1, Katherine A Kirkwood2, Helena L Chang2
1Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
The Annals of Thoracic Surgery
|December 11, 2017
Summary
Mediastinal infections after cardiac surgery are rare but serious, increasing hospital stay, readmissions, and death. Managing blood sugar post-operation may reduce infection risk in non-diabetic patients.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Mediastinal infections are severe complications following cardiac operations.
- These infections can significantly impact patient outcomes, including readmissions and mortality.
Purpose of the Study:
- To analyze the incidence, risk factors, and perioperative outcomes of mediastinal infections after cardiac operations.
- To identify patient characteristics and surgical variables associated with an increased risk of mediastinal infection.
Main Methods:
- A prospective study of 5,158 patients undergoing cardiac operations was conducted.
- Data on clinical characteristics, operative variables, management, and outcomes were collected and compared between patients with and without mediastinal infections.
Main Results:
- The cumulative incidence of mediastinal infection was 0.79%, with 65% occurring after hospital discharge.
- Risk factors included higher BMI, elevated creatinine, peripheral vascular disease, corticosteroid use, and ventricular assist device or transplant surgery.
- Mediastinal infection led to an 11.5-day increase in hospital stay and a fivefold increase in readmission rates and mortality.
Conclusions:
- Mediastinal infections significantly increase length of stay, readmissions, and mortality after cardiac surgery.
- Reducing mediastinal infections is a critical priority.
- Improving postoperative glycemic management may lower infection risk in patients without diabetes.
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