Risk factors for mediastinitis after cardiac surgery - a retrospective analysis of 1700 patients.
BACKGROUND
Mediastinitis is a rare, but serious complication of cardiac surgery. It has a significant socioeconomic impact and high morbidity. The purpose of this study was to determine pre-, intra-, and postoperative predictors of mediastinitis.


RESULTS
In 1700 consecutive patients, who underwent cardiac surgery in 2001, 49 variables were retrospectively assessed. Forty-five patients (2.65%, 95% CI [1.88; 3.41]) developed postoperative mediastinitis. None of these patients died during their hospitalization. Multivariate analysis identified three of the 49 variables as highly significant independent predictors for the development of mediastinitis: obesity (OR 1.03, 95% CI [1.01; 1.04] p = 0.001), chronic obstructive pulmonary disease (OR 3.30, 95% CI [1.58; 6.88], p = 0.001), and bilateral grafting of the internal mammary artery (OR 3.18, 95% CI [1.20; 8.43] p = 0.02). The model is reliable in terms of its goodness of fit, it also discriminates well. Additionally, univariate analysis identified diabetes mellitus, CCS class and the number of intraoperatively transfused units of fresh frozen plasma as variables with a significant impact.


CONCLUSIONS
The present study suggests that bilateral IMA grafting, chronic obstructive pulmonary disease and obesity are important predictors of mediastinitis.
Diez
Claudius
C
Department of Cardiothoracic Surgery, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str, 40, D-06097 Halle/Saale, Germany. claudius.diez@t-online.de
Koch
Daniel
D
Kuss
Oliver
O
Silber
Rolf-Edgar
RE
Friedrich
Ivar
I
Boergermann
Jochen
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008480:Mediastinitis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011336:Probability; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
D000900:Anti-Bacterial Agents