title: Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients.
abstract: BACKGROUND
  Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons.
  
  
  OBJECTIVE
  To identify risk factors for mediastinitis in diabetics undergoing CABG surgery with use of unilateral ITA in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE.
  
  
  METHODS
  Retrospective study of 157 diabetics operated between May 2007 and April 2010. Nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were applied.
  
  
  RESULTS
  The incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016), postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049) and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95 to 61.6, P=0.048), in comparison to skeletonized ITA.
  
  
  CONCLUSIONS
  We suggest that diabetics should be considered for strategies to minimize risk of infection. In diabetics that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Diabetics should always be considered for use of skeletonized ITA.
authors: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Faculty of Medical Sciences, University of Pernambuco, Recife, Brazil. michel_pompeu@yahoo.com.br
authors: Michel Pompeu Barros de Oliveira
authors: MP
authors: Sá
authors: Evelyn Figueira
authors: EF
authors: Soares
authors: Cecília Andrade
authors: CA
authors: Santos
authors: Omar Jacobina
authors: OJ
authors: Figueiredo
authors: Renato Oliveira Albuquerque
authors: RO
authors: Lima
authors: Rodrigo Renda
authors: RR
authors: Escobar
authors: Fábio Gonçalves de
authors: FG
authors: Rueda
authors: Paulo Ernando
authors: PE
authors: Ferraz
authors: Ricardo Carvalho
authors: RC
authors: Lima
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008480:Mediastinitis / Q000209:etiology*; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors