Mediastinal infection after open heart surgery.

Area of Science:

• Cardiovascular Surgery
• Infectious Disease
• Critical Care Medicine

Background:

• Mediastinal infection is a serious complication following median sternotomy for cardiac operations.
• The incidence and risk factors for mediastinitis require ongoing investigation to improve patient outcomes.

Purpose of the Study:

• To identify factors associated with the development of mediastinitis after median sternotomy.
• To determine factors influencing mortality in patients with mediastinitis.
• To evaluate the effectiveness of mediastinal exploration and wound management strategies.

Main Methods:

• Retrospective analysis of 2031 patients undergoing median sternotomy between 1956 and 1981.
• Statistical analysis to identify risk factors for mediastinitis and associated mortality.
• Comparison of outcomes based on treatment strategies, including mediastinal exploration and wound closure methods.

Main Results:

• Mediastinitis occurred in 1.4% of patients, primarily associated with postoperative complications like low cardiac output and reoperation.
• Preoperative patient characteristics did not significantly predict mediastinitis development.
• Mortality in mediastinitis patients was 52%, influenced by preoperative functional class, operation type, organism, and pneumonia.
• Mediastinal exploration for treatment resulted in a significantly lower mortality rate (35% vs. 73%).
• Wound management (closed over drainage vs. packed open) did not impact survival but prolonged hospital stay when packed open.

Conclusions:

• Postoperative complications, not preoperative factors, are key predictors of mediastinitis after cardiac surgery.
• Prompt mediastinal exploration is crucial for reducing mortality in infected patients.
• While wound packing affects hospital stay, it does not influence survival rates.