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Ann Thorac Surg 1998;66:601
© 1998 The Society of Thoracic Surgeons

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Correspondence

Postoperative mediastinitis and ß-adrenergic drugs

^a Department of Cardiac Surgery, Prince Sultan Cardiac Center, X 965 Armed Forces Hospital,, PO Box 7897, Riyadh 11159, Kingdom of Saudi Arabia

To the Editor

We read with interest the article "Mediastinitis After Cardiovascular Operations: A Case-Control Study of Risk Factors" [1]. In a conditional logistic regression analysis, Bitkover and Grdlund found perioperative use of ß-adrenergic drugs (not chronic obstructive airway disease) to be an independent risk factor for postoperative mediastinitis. The potential mechanism(s) by which ß-agonists predispose to wound complications have not been discussed; however, the use of vasoactive compounds could alter the homeostatic milieu within the organ of healing [2]. Unfortunately, Bitkover and Grdlund failed to mention the name, dose, and route of administration of the agent(s) used in their study.

Bitkover and Grdlund have been painstakingly thorough in the analysis of the variables in their retrospective case-control study. However, the statistical significance of analyzing 54 risk factors with 37 patients and 74 matched controls is rather questionable. We think the deduction that "use of ß-adrenergic drugs for respiratory problems was significantly associated with a diagnosis of [chronic obstructive pulmonary disease], reoperation, operation time, use of temporary pacing wires, and diabetes" and hence an increased risk of mediastinitis may be a statistical aberration [1]. The cause-and-effect relationship of use of ß-adrenergic drugs and mediastinitis, if any, could be clarified in a prospective study of patients undergoing cardiopulmonary bypass who are receiving ß-adrenergic drugs. The other possible objection is that Bitkover and Grdlund chose some factors with a statistical significance of p less than 0.2 after their univariate analysis to be included in the next multivariate logistic regression analysis.

The other findings in their study are very much in agreement with previous reports [3, 4]. We wish to reiterate the importance of applying sound surgical principles in preventing postoperative mediastinitis [4]. Technical factors such as faulty sternotomy, excessive use of bone wax, indiscriminate use of diathermy, and inadequate sternal stabilization are also important risk factors for poor wound healing and mediastinal infection after median sternotomy [4].

References

1. Bitkover Y.C., Grdlund B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 1998;65:36-40.[Abstract/Free Full Text]
2. Appleton I. Wound repair: the role of cytokines and vasoactive mediators [Editorial]. J R Soc Med 1994;87:500-502.[Medline]
3. Nagachinta T., Stephens M., Reitz B., Polk F.B. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987;156:967-973.[Abstract/Free Full Text]
4. El Oakley R.M., Wright J.E. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996;61:1030-1036.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Reida M. El Oakley Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Syed, A. U. Articles by El Oakley, R. M. Search for Related Content PubMed PubMed Citation Articles by Syed, A. U. Articles by El Oakley, R. M.