Closed drainage using redon catheters for poststernotomy mediastinitis: results and risk factors for adverse outcome.
BACKGROUND
Several different surgical techniques have been described for the treatment of poststernotomy mediastinitis. The present study was undertaken to evaluate the midterm results of primary closed drainage using Redon catheters and to identify risk factors for adverse outcome.


METHODS
Hospital records of 72 patients in whom poststernotomy mediastinitis developed and who underwent closed drainage with Redon catheters between April 1, 1996, and December 31, 1999, were reviewed. Follow-up was complete and averaged 11.8 +/- 11.5 months.


RESULTS
Of the 25 deaths (34.7%) recorded, 15 were directly attributable to mediastinitis. Actuarial estimates for freedom from mediastinitis-related death were 80.1% at 1 month and 77.4% at 1 year, 2 years, and 3 years. Logistic regression identified older age (odds ratio, 1.1; 95% confidence interval, 1.02 to 1.18), incubation time of 14 days or less (6.5; 1.33 to 31.4), and methicillin-resistant Staphylococcus aureus (5.8; 1.2 to 27.2) as independent risk factors for mediastinitis-related death. Reintervention for recurrent mediastinitis was necessary in 9 patients (12.5%) and occurred at a mean interval of 18.7 +/- 13.5 days from the first debridement. Actuarial estimates for freedom from reintervention were 87.1% at 1 month and 85.2% at 1 year, 2 years, and 3 years. The combined end point of treatment failure (mediastinitis-related death or reintervention) was recorded in 9 patients (26.4%). Actuarial estimates for freedom from treatment failure were 74.3% at 1 month and 72.7% at 1 year, 2 years, and 3 years. Logistic regression identified older age (1.01; 1.02 to 1.18), preoperative renal insufficiency (6.8; 1.04 to 44.5), and methicillin-resistant S aureus infection (4.8; 1.04 to 22.33) as independent risk factors for treatment failure (includes mediastinitis-related death and reintervention [with or without death]).


CONCLUSIONS
Primary closed drainage using Redon catheters is an effective and simple treatment for most patients in whom poststernotomy mediastinitis develops. However, patients with methicillin-resistant S aureus infection or recurrent mediastinitis may benefit from a more aggressive approach.
Kirsch
M
M
Service de Chirurgie Thoracique et Cardiovasculaire, Hĵpital Henri Mondor, Créteil, France.
Mekontso-Dessap
A
A
Houël
R
R
Giroud
E
E
Hillion
M L
ML
Loisance
D Y
DY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D002423:Cause of Death; D005260:Female; D005602:France; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000401:mortality / Q000628:therapy*; D016106:Methicillin Resistance; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality / Q000628:therapy*; D013396:Suction / Q000295:instrumentation*; D013530:Surgical Wound Infection / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome