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Ann Thorac Surg 2006;82:1784-1789
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Mediastinitis After More Than 10,000 Cardiac Surgical Procedures

^a Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
^b Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
^c Department of Infectious Disease Epidemiology, National Public Health Institute, University of Helsinki, Helsinki, Finland

Accepted for publication May 25, 2006.

^_* Address correspondence to Dr Eklund, HUCH, Jorvi Hospital, Department of Surgery, Turuntie 150, FIN-02740 Espoo, Finland (Email: anne.eklund{at}fimnet.fi).

BACKGROUND: Poststernotomy mediastinitis as a complication is rare but disastrous. We assessed incidence, predisposing factors for, and outcome from, mediastinitis after cardiac surgery.

METHODS: We studied 10,713 consecutive patients who underwent open-heart surgery from 1990 to 1999 in a tertiary care university hospital using data prospectively recorded in the hospital discharge register, operating room log, and the hospital's cardiothoracic surgery unit register. Those cases with possible mediastinitis were identified from the hospital infection register and discharge register. Patients' charts were reviewed and cases of mediastinitis confirmed based on criteria of the Centers for Disease Control and Prevention.

RESULTS: The overall rate of mediastinitis was 1.1% (120 cases), and higher in coronary artery bypass surgery than in valvular surgery (1.2 vs 0.8%). No trend in incidence was detectable, although surgical patients became progressively older (mean age, 59 to 65 years, p < 0.01), and the proportion of women (from 25% to 31%; p < 0.01) and of patients with American Society of Anesthesiologists score over 3 (from 10% to 81%, p < 0.01) both increased. The rate of mediastinitis was almost twice as high in men (1.2% vs 0.7%, p < 0.01). In three body mass index (BMI) categories (<25, 25 to 30, and >30 kg/m²), rates of mediastinitis were 0.5%, 1.0%, and 1.8%. In multivariate analysis adjusted for age, sex, year, operation type, and perfusion time, the only predictor for mediastinitis was BMI.

CONCLUSIONS: Mediastinitis is not diminishing. Larger populations at risk, for example proportions of overweight patients, reinforce the importance of surveillance and pose a challenge in focusing preventive measures.

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