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Ann Thorac Surg 1998;65:36-40
© 1998 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Mediastinitis After Cardiovascular Operations: A Case-Control Study of Risk Factors

Catarina Y. Bitkover, MD, Bengt Gårdlund, PhD

Department of Cardiothoracic Surgery, Karolinska Hospital, Stockholm, Sweden
Department of Infectious Diseases, Karolinska Hospital, Stockholm, Sweden

Accepted for publication July 5, 1997.

Dr Bitkover, Department of Cardiothoracic Surgery, Karolinska Hospital, S-171 76 Stockholm, Sweden.

Background. An analysis of risk factors for postoperative mediastinitis can lead to a better understanding of the pathogenesis of this complication and to more effective preventive measures.

Methods. This case-control study of 37 patients and 74 matched controls evaluated 54 potential risk factors.

Results. Nine variables were significantly associated with increased risk of postoperative mediastinitis: total operation time (p = 0.0013), high body-mass index (p = 0.0033), use of ß-adrenergic drugs before the onset of infection (p = 0.0037), long cardiopulmonary bypass time (p = 0.0072), long aortic cross-clamp time (p = 0.0075), presence of diabetes (p = 0.0122), high body weight (p = 0.0130), and use and duration of temporary pacing wires (p = 0.0293 and p = 0.0241 respectively). In a conditional logistic regression analysis, use of ß-adrenergic drugs before the onset of infection (p = 0.0058; odds ratio 19.7; 95% confidence limits, 2.37 and 163.7) and body mass index (p = 0.0082; odds ratio 1.27; 95% confidence limits, 1.06 and 1.52) were independently associated with a significantly increased risk of postoperative mediastinitis.

Conclusions. Obesity and use of ß-adrenergic drugs, which is indicative of obstructive respiratory problems, were the most important risk factors suggesting that mechanical strain on the sternotomy and sternal instability may precede infection. Targeted preventive measures for these groups could be justified.






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