title: Does method of sternal repair influence long-term outcome of postoperative mediastinitis?
abstract: BACKGROUND
  Post-sternotomy mediastinitis reduces survival after cardiac surgery, potentially further affected by details of mediastinal vascularized flap reconstruction. The aim of this study was to evaluate survival after different methods for sternal reconstruction in mediastinitis.
  
  
  METHODS
  Two hundred twenty-two adult cardiac surgery patients with post-sternotomy mediastinitis were reviewed. After controlling infection, often augmented by negative pressure therapy, muscle flap, omental flap, or secondary closure was performed. Outcomes were reviewed and survival analysis was performed.
  
  
  RESULTS
  Baseline characteristics were similar. In-hospital mortality (15.7%) did not differ between groups. Secondary closure was correlated with negative pressure therapy and reduced length hospital of stay. Recurrent wound complications were more common with muscle flap repair. Survival was unaffected by sternal repair technique. By multivariate analysis, heart failure, sepsis, age, and vascular disease independently predicted mortality, while negative pressure therapy was associated with survival.
  
  
  CONCLUSIONS
  Choice of sternal repair was unrelated to survival, but mediastinal treatment with negative pressure therapy promotes favorable early and late outcomes.
authors.affiliation: Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, USA. broadus.atkins@va.gov
authors.forename: B Zane
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: Kelley A
authors.initials: KA
authors.lastname: Hutcheson
authors.forename: Keith
authors.initials: K
authors.lastname: Kaye
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Petersen
authors.forename: Walter G
authors.initials: WG
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D003646:Debridement; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008480:Mediastinitis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008482:Mediastinum / Q000382:microbiology / Q000601:surgery; D015999:Multivariate Analysis; D054843:Negative-Pressure Wound Therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum / Q000601:surgery; D013524:Surgical Flaps; D014652:Vascular Diseases / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents