title: Is early tracheostomy a risk factor for mediastinitis after median sternotomy?
abstract: Early tracheostomy may increase the risk of mediastinitis after median sternotomy. Patients who had postoperative tracheostomy after cardiac surgery in the period 2000-2005 were retrospectively analyzed (total: 5095 patients) to evaluate the incidence of mediastinitis and sternal wound infections. Fifty-seven cases (1.1% of all operated patients) had postoperative tracheostomy at an average 5.6 +/- 0.7 days postoperatively. None of these patients had mediastinitis. Eleven cases of aseptic sternal instability and ten cases of mild-to-moderate infection limited to subcutaneous planes were observed. There was no correlation between the time to performance of tracheostomy and the isolation of bacteria from the thoracic wounds (p = 0.61). The bacterial strains isolated from subcutaneous infection were qualitatively and quantitatively different from those isolated from bronchial secretions. We conclude that in this study there is no demonstrable link between early tracheostomy after sternotomy and mediastinitis. Early tracheostomy should not be denied due to concerns of increasing the risk of mediastinitis.
authors.affiliation: Division of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@tiscali.it
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Losasso
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Roberto
authors.initials: R
authors.lastname: Zamparelli
authors.forename: Rocco
authors.initials: R
authors.lastname: Schiavello
authors.forename: Gianfederico
authors.initials: G
authors.lastname: Possati
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000209:etiology* / Q000401:mortality; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000401:mortality; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality; D014139:Tracheostomy / Q000379:methods*