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J Thorac Cardiovasc Surg 2006;132:537-543
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Risk factors for 1-year mortality after postoperative mediastinitis

Departments of Medicine and Surgery, Division of Infectious Diseases, Duke University Medical Center, Durham, NC.

Received for publication February 8, 2006; revisions received March 29, 2006; accepted for publication April 11, 2006.

^_* Address for reprints: Ravi Karra, MD, MHS, Brigham and Women's Hospital, PBB-B-4, 75 Francis St, Boston, MA 02115 (Email: rkarra{at}partners.org).

OBJECTIVE: Postoperative mediastinitis after median sternotomy is associated with disability and mortality. The aim of this study was to identify risk factors for mortality 1 year after postoperative mediastinitis diagnosis.

METHODS: Postoperative mediastinitis was defined as an organ-space infection involving the mediastinum and necessitating debridement. A total of 183 cases of postoperative mediastinitis were prospectively identified from infection control databases. By using univariate and multivariate analysis, clinical risk factors for 1-year mortality were identified.

RESULTS: Of 183 patients, 36 (19.7%) died within 3 months of the initial operation. Overall, 51 (33%) died during the study period (the median time to death from the date of diagnosis was 37 days [interquartile range, 11,139 days]). In multivariate analysis, independent predictors of 1-year mortality were a greater than 3-day delay in sternal closure after debridement (hazard ratio, 6.27; P < .001), age greater than 65 years (hazard ratio, 2.29; P = .015), serum creatinine level greater than 2 mg/dL before debridement (hazard ratio, 2.52; P = .019), stay in an intensive care unit before sternal debridement (hazard ratio, 5.56; P < .001), and postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus (hazard ratio, 2.13; P = .02). Treatment with antibiotics with in vitro activity against the infecting pathogen within 7 days of initial debridement was associated with a decreased risk for mortality (hazard ratio, 0.40; P = .03).

CONCLUSIONS: Our data suggest that, to improve long-term survival, patients with postoperative mediastinitis should undergo sternal closure within 72 hours after sternal debridement and should receive effective antimicrobial therapy based on operative culture results.

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