Does method of sternal repair influence long-term outcome of postoperative mediastinitis?

• Published in: The American journal of surgery Vol. 202; no. 5; pp. 565 - 567
• Main Authors: Atkins, B. Zane, M.D, Onaitis, Mark W., M.D., M.Sc, Hutcheson, Kelley A., M.D, Kaye, Keith, M.D., M.P.H, Petersen, Rebecca P., M.D., M.Sc, Wolfe, Walter G., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier; Elsevier Limited
• Subjects: Adult; Age; Age Factors; Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Cardiac surgery; Cardiovascular disease; Cardiovascular Surgical Procedures - adverse effects; Complications; Coronary vessels; Debridement; General aspects; Heart; Heart diseases; Heart failure; Heart Failure - epidemiology; Heart surgery; Hospital costs; Hospital Mortality; Humans; Infection; Infections; Influence; Length of Stay; Mediastinitis; Mediastinitis - etiology; Mediastinitis - mortality; Mediastinitis - therapy; Mediastinum - microbiology; Mediastinum - surgery; Medical sciences; Methods; Mortality; Multivariate Analysis; Negative-Pressure Wound Therapy; Postoperative period; Pressure; Repair; Retrospective Studies; Risk factors; Sepsis; Sepsis - epidemiology; Staphylococcus infections; Sternotomy - adverse effects; Sternum - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgical Flaps; Survival; Survival analysis; Therapy; Thoracic; Vascular Diseases - epidemiology; Wounds; Infection; Thoracic; Cardiac surgery; Mediastinitis; Postoperative; Prognosis; Methodology; Sternum; Mediastinum disease; Thorax; Method; Long term; Medicine; Evolution; Repair
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.06.013

Abstract Background Post-sternotomy mediastinitis reduces survival after cardiac surgery, potentially further affected by details of mediastinal vascularized flap reconstruction. The aim of this study was to evaluate survival after different methods for sternal reconstruction in mediastinitis. Methods Two hundred twenty-two adult cardiac surgery patients with post-sternotomy mediastinitis were reviewed. After controlling infection, often augmented by negative pressure therapy, muscle flap, omental flap, or secondary closure was performed. Outcomes were reviewed and survival analysis was performed. Results Baseline characteristics were similar. In-hospital mortality (15.7%) did not differ between groups. Secondary closure was correlated with negative pressure therapy and reduced length hospital of stay. Recurrent wound complications were more common with muscle flap repair. Survival was unaffected by sternal repair technique. By multivariate analysis, heart failure, sepsis, age, and vascular disease independently predicted mortality, while negative pressure therapy was associated with survival. Conclusions Choice of sternal repair was unrelated to survival, but mediastinal treatment with negative pressure therapy promotes favorable early and late outcomes.