Preoperative hospital length of stay as a modifiable risk factor for mediastinitis after cardiac surgery

Abstract

BackgroundAs high-risk cardiac patients frequently remain within hospital while waiting for surgery, the aim of the present study was to determine the role of preoperative length of hospital stay on mediastinitis, and also, to assess contemporary risk factors for this complication.MethodsThe source population consisted of 6653 consecutive patients undergoing coronary bypass surgery, valve surgery, or both between September 2000 and September 2009 at a single tertiary care hospital. A retrospective cohort analysis was used to assess the effect of 18 preoperative variables, including length of stay, on mediastinitis.ResultsMediastinitis developed in 108 patients (1.6%) resulting in an in-hospital mortality rate of 13.9%. Independent predictors of mediastinitis included obesity (2.59, CI 1.58-4.23), COPD (2.44, CI 1.55-3.84), diabetes (2.16, CI 1.44-3.24), and impaired estimated glomerular filtration rate. Preoperative hospital stay was also found to be an independent risk factor leading to a 15% increased risk of mediastinitis per week of stay. The primary wound pathogen was coagulase negative staphylococcus (82%) followed by multi-flora isolates (49%), but was unrelated to hospital stay.ConclusionsIn addition to the traditional risk factors, prolonged preoperative hospital stay is also a significant and potentially modifiable predictor for the development of mediastinitis following cardiac surgery. All efforts should be made to minimize the delay in operating on hospitalized patients awaiting heart surgery.

Perfil clínico-cirúrgico de pacientes com mediastinite pós-cirurgia cardíaca: estudo transversal retrospectivo

“…Soma-se a esses aspectos o tempo de internação pré-operatório. Um estudo demonstrou que cada semana de internação hospitalar no pré-operatório aumenta em 15% o risco de mediastinite, associado ao prolongamento do jejum pré-operatório, que compromete a nutrição adequada e a recuperação pós-operatória dos pacientes 14 . Ademais, eleva o risco de desenvolvimento de complicações infecciosas, entre elas as infecções do sítio cirúrgico, a admissão em UTI e o uso de dispositivos invasivos (cateter venoso central, sonda vesical de demora e ventilação mecânica), que tornam o paciente suscetível a infecções ligadas à assistência à saúde 15 .…”

Defining post-sternotomy mediastinitis for clinical evidence-based studies

“…There has been an alarming and significant increase in the incidence of post-sternotomy mediastinitis (PSM) due to slower-growing pathogens such as (the deceptive) coagulase-negative staphylococcus (CoNS) and certain fungi since 1997. 2,11,34,41 This shift in the spectrum of causative pathogens has been reported and may have accelerated in recent years. 42 Up to 2007, Staphylococcus aureus and/or CoNS were the most prevalent pathogens encountered in PSM.…”

“…Patients particularly at risk for CoNS-related PSM are those afflicted by diabetes mellitus, 35 by chronic obstructive pulmonary disease, or obese patients, especially when a prolonged preoperative stay was required or where an incision drape was used during a lengthy operation. 41,60…”

Potential risk factors for surgical site infection after isolated coronary artery bypass grafting in a Bahrain Cardiac Centre: A retrospective, case-controlled study

“…Some studies have shown a relationship between prolonged perioperative hospital stay and SSIs. [ 31 32 33 ] We looked at prolonged perioperative hospital stay (>30 days) and found only 2 patients from our study group had a prolonged hospital stay. However, controversy remains regarding the role of a prolonged perioperative hospital stay.…”