title: Preoperative hospital length of stay as a modifiable risk factor for mediastinitis after cardiac surgery.
abstract: BACKGROUND
  As high-risk cardiac patients frequently remain within hospital while waiting for surgery, the aim of the present study was to determine the role of preoperative length of hospital stay on mediastinitis, and also, to assess contemporary risk factors for this complication.
  
  
  METHODS
  The source population consisted of 6653 consecutive patients undergoing coronary bypass surgery, valve surgery, or both between September 2000 and September 2009 at a single tertiary care hospital. A retrospective cohort analysis was used to assess the effect of 18 preoperative variables, including length of stay, on mediastinitis.
  
  
  RESULTS
  Mediastinitis developed in 108 patients (1.6%) resulting in an in-hospital mortality rate of 13.9%. Independent predictors of mediastinitis included obesity (2.59, CI 1.58-4.23), COPD (2.44, CI 1.55-3.84), diabetes (2.16, CI 1.44-3.24), and impaired estimated glomerular filtration rate. Preoperative hospital stay was also found to be an independent risk factor leading to a 15% increased risk of mediastinitis per week of stay. The primary wound pathogen was coagulase negative staphylococcus (82%) followed by multi-flora isolates (49%), but was unrelated to hospital stay.
  
  
  CONCLUSIONS
  In addition to the traditional risk factors, prolonged preoperative hospital stay is also a significant and potentially modifiable predictor for the development of mediastinitis following cardiac surgery. All efforts should be made to minimize the delay in operating on hospitalized patients awaiting heart surgery.
authors.affiliation: Divisions of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Quebec, H3A 1A3, Montreal, Canada.
authors.forename: Stephane
authors.initials: S
authors.lastname: Leung Wai Sang
authors.forename: Rakesh
authors.initials: R
authors.lastname: Chaturvedi
authors.forename: Ahsan
authors.initials: A
authors.lastname: Alam
authors.forename: Gordan
authors.initials: G
authors.lastname: Samoukovic
authors.forename: Benoit
authors.initials: B
authors.lastname: de Varennes
authors.forename: Kevin
authors.initials: K
authors.lastname: Lachapelle
mesh_terms: D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D002170:Canada / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008480:Mediastinitis / Q000453:epidemiology* / Q000382:microbiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors