Factores asociados a la aparición de mediastinitis en revascularizacion miocárdica

Abstract

Objective: Mediastinitis occurs in up to 4% of patients undergoing coronary artery bypass grafting with reported hospital mortality from 14 to 47%, with increased care costs, deteriorating quality of life and long-term survival; the etiology is multifactorial. The aim of this study was to establish which risk factors preoperative as well as those related to the surgical procedure are associated with development mediastinitis. Methods: We designed a nested case-control study in a historical cohort of patients undergoing coronary artery bypass grafting between January 2005 and July 2011. Patients with mediastinitis were compared with a control group without mediastinitis taken from the same risk group in a 1:4 ratio and matched for date of surgery. The diagnosis of mediastinitis was based on clinical, laboratory, and surgical findings. Results: We identified 30 cases of mediastinitis in that period with 120 controls. Factors associated with the occurrence of the event were: Diabetes Mellitus OR 2.3 (1.1-4.9), use cardiopulmonary bypass OR 2.4 (1.1 -5.5), CPB time OR 1.1 (1,1 -1.3), age > 70 OR 1.1 (1,2-1,4). Conclusion: Despite a low prevalence, mediastinitis remains a devastating complication. The clinical and economic impact of which should be surgical groups to develop preventive strategies based on knowledge of risk factors for its population.