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[Suppurative mediastinitis after open heart surgery: in comparison between infants-children and adults]
1Second Department of Surgery, Yamagata University School of Medicine, Japan.
Insights
Mediastinitis risk factors differ between adult and pediatric open surgery patients. Adults face higher risks with low output syndrome and reexploration, while infants
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Pediatric Surgery
Background:
- Postoperative mediastinitis is a serious complication following open chest surgery.
- Risk factors and clinical outcomes for mediastinitis have not been extensively compared between pediatric and adult populations.
Purpose of the Study:
- To retrospectively analyze and compare risk factors and clinical courses of mediastinitis in infants-children versus adults undergoing open surgery.
- To identify specific patient characteristics and perioperative factors associated with mediastinitis in different age groups.
Main Methods:
- Retrospective analysis of 361 consecutive patients who underwent open surgery between January 1987 and September 1991.
- Comparison of mediastinitis incidence, risk factors, and outcomes between adult (20-75 years) and pediatric (0-17 years) patient cohorts.
- Statistical analysis to determine significant associations between patient factors and mediastinitis development.
Main Results:
- Seven cases (4.0%) of mediastinitis occurred in 173 adult patients; risk factors included low output syndrome (LOS) and reexploration for bleeding/tamponade.
- Five cases (2.7%) of mediastinitis occurred in 188 infants and children, primarily in those under 12 months old.
- Bacterial cultures identified MRSA in 10 of 12 positive cases; adult patients had higher mortality (sepsis, organ failure, bleeding), while pediatric patients healed.
Conclusions:
- Postoperative mediastinitis presents different risk factors and outcomes in adult versus pediatric patients.
- In adults, low output syndrome and reexploration are significant risk factors, possibly linked to immune suppression and cardiac dysfunction.
- In infants, immature immune response may contribute to mediastinitis, with a generally better prognosis compared to adults.
Abstract:
Among 361 consecutive patients who underwent open surgery from Jan. 1987 to Sept. 1991, risk factors and clinical courses were analyzed retrospectively in comparison between infants-children and adults. Seven mediastinitis (4.0%) occurred in 173 adult patients (20 to 75 y/o, mean: 54.4 y/o) and were not associated with age, sex, type of disease, and duration of operation or cardiopulmonary bypass. Postoperative mediastinitis significantly increased in the patients with low output syndrome (LOS) determined as use of IABP and/or assistant circulations (p < 0.001) and reexploration for bleeding or tamponase was associated with an increased risk for mediastinitis (p < 0.01). Five mediastinitis (2.7%) occurred in 188 infants and children (0 to 17 y/o, mean: 4.2 y/o). All patients involved with mediastinitis were less than 12 month old (2.6 +/- 3.3 month). None of the other factors was associated with an increased risk for this complication. Bacterial cultures of exudate were positive in 11 of 12 patients, and identified as MRSA in 10 and Staphylococcus epidermidis in one. In the seven of adult patients, two developed sepsis and four died with other organic failures or mediastinal bleeding. All five of infants healed after postoperative 33 to 145 days. The immature state of immune response might associate with postoperative mediastinitis in infants, whether LOS may be important in the immune suppression by surgical stress in adults, and the prognosis of mediastinitis might be effected by prolonged depression of postoperative cardiac function in adult patients.