Risk factors for 1-year mortality after postoperative mediastinitis.
OBJECTIVE
Postoperative mediastinitis after median sternotomy is associated with disability and mortality. The aim of this study was to identify risk factors for mortality 1 year after postoperative mediastinitis diagnosis.


METHODS
Postoperative mediastinitis was defined as an organ-space infection involving the mediastinum and necessitating debridement. A total of 183 cases of postoperative mediastinitis were prospectively identified from infection control databases. By using univariate and multivariate analysis, clinical risk factors for 1-year mortality were identified.


RESULTS
Of 183 patients, 36 (19.7%) died within 3 months of the initial operation. Overall, 51 (33%) died during the study period (the median time to death from the date of diagnosis was 37 days [interquartile range, 11,139 days]). In multivariate analysis, independent predictors of 1-year mortality were a greater than 3-day delay in sternal closure after debridement (hazard ratio, 6.27; P < .001), age greater than 65 years (hazard ratio, 2.29; P = .015), serum creatinine level greater than 2 mg/dL before debridement (hazard ratio, 2.52; P = .019), stay in an intensive care unit before sternal debridement (hazard ratio, 5.56; P < .001), and postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus (hazard ratio, 2.13; P = .02). Treatment with antibiotics with in vitro activity against the infecting pathogen within 7 days of initial debridement was associated with a decreased risk for mortality (hazard ratio, 0.40; P = .03).


CONCLUSIONS
Our data suggest that, to improve long-term survival, patients with postoperative mediastinitis should undergo sternal closure within 72 hours after sternal debridement and should receive effective antimicrobial therapy based on operative culture results.
Karra
Ravi
R
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA. rkarra@partners.org
McDermott
Lisa
L
Connelly
Sarah
S
Smith
Peter
P
Sexton
Daniel J
DJ
Kaye
Keith S
KS
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000401:mortality* / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000401:mortality* / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors