Acute Mediastinitis – Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience)

Abstract

The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors' worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy. Methods: During the period 2006-2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment. Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times. Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.

Surgical Therapy and Outcome of Descending Necrotizing Mediastinitis in a Single- Center Series

“…Hypertension (48%) and DM (42%) were the most commonly observed comorbidities. Since hypertension and DM are major comorbidities in China and most of our patients had a low socioeconomic status with poor awareness of medical care, the proportion of hypertension and DM among these patients was greater than that in some previous studies (hypertension 18%-33%, DM 18%-28%) [9,11].…”

“…For type I DNM limited to the upper part of the mediastinum, drainage via cervicotomy or videomediastinum copies may be su cient [11,19,20]. However, in cases of type II DNM, access via thoracotomy combined with transcervical debridement is often recommended [11,12,21]. Some researchers prefer median sternotomy and clamshell thoracotomy, which exposes and debrides the entire mediastinum [3,22,23].…”

“…Some researchers prefer median sternotomy and clamshell thoracotomy, which exposes and debrides the entire mediastinum [3,22,23]. However, osteomyelitis or dehiscence of the sternum and approaches for repeat revision surgeries remain major problems [11]. An increasing number of studies have reported treatment of DNM using video-assisted thoracoscopic surgery.…”

“…Therefore, in this study, VATS was performed in most patients, and only two patients underwent thoracotomy. Some studies have suggested that VATS may not allow su cient debridement in advanced cases [11,17,27]. Ultrasound-or CT-guided percutaneous drainage is very effective in managing these small residual in ammatory collections.…”

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

“…The concurrent diagnosis of DNI and descending mediastinitis usually requires treatment from a multidisciplinary department containing otorhinolaryngological care, infection control, thoracic surgery, and an intensive care unit for life-sustaining management [47]. In addition to effective antibiotic treatment, respiratory security and timely drainage of the deep neck space and mediastinum are mandatory [48]. The placement of drainage tubes and appropriate irrigation to prevent the possible formation of recurrent abscesses or the collection of purulent discharge are also necessary [47].…”