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. 2014 Oct;88(2):96-102.
doi: 10.1016/j.jhin.2014.06.011. Epub 2014 Jul 21.

Risk factors for mediastinitis following cardiac surgery: the importance of managing obesity

S M Rehman  1 , O Elzain  2 , J Mitchell  2 , B Shine  3 , I C J W Bowler  4 , R Sayeed  2 , S Westaby  2 , C Ratnatunga  2
Affiliations

Risk factors for mediastinitis following cardiac surgery: the importance of managing obesity

S M Rehman et al. J Hosp Infect. 2014 Oct.

Abstract

Background: Mediastinitis is a devastating complication of cardiac surgery. Previous studies have often observed small populations, been retrospective in design, and used a variety of definitions for mediastinitis.

Aim: To identify risk factors for mediastinitis, and strategies to minimize its incidence.

Methods: A prospective cohort study of 4883 adult patients who underwent cardiac surgery between October 2003 and February 2009, comparing pre- and peri-operative risk factors, microbial aetiology, requirement for re-admission, length of stay and mortality between patients with and without mediastinitis.

Findings: Ninety (1.8%) patients were diagnosed with mediastinitis. Microbial aetiology was defined for 75 patients. Staphlyocococcus aureus was the most common isolate (30 episodes; 15 due to meticillin-resistant S. aureus). Univariate analysis revealed the following pre-operative factors associated with mediastinitis: age; body mass index; diabetes; modified logistic European System for Cardiac Operative Risk Evaluation score; urgent admission; and longer pre-operative stay (P < 0.05). Associated peri-operative factors were: combined coronary artery bypass grafting plus aortic valve replacement; longer aortic cross-clamp time; and longer cardiopulmonary bypass time (P < 0.005). Multi-variate analysis revealed that higher body mass index, combined coronary artery bypass grafting plus aortic valve replacement, and older age were associated with mediastinitis (P < 0.05). Mediastinitis was associated with re-admission to hospital, longer inpatient stay and reduced long-term survival (P < 0.05).

Conclusion: Mediastinitis is associated with worse short-term outcomes (re-admission, length of stay) and reduced long-term survival. Obesity is the only modifiable pre-operative risk factor for mediastinitis. It may be possible to reduce risk through pre-operative weight loss programmes before elective surgery.

Keywords: Cardiac surgery; Mediastinitis; Obesity.

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