ABSTRACT
The mortality rate of patients with poststernotomy mediastinitis remains very high. The aim of this study was to identify the risk factors associated with mortality in these patients. Surveillance of sternal surgical-site infections including mediastinitis was carried out for adult patients undergoing a sternotomy between 2004 and 2012. Criteria from the US Centers for Disease Control and Prevention were used to make the diagnosis. All data on patients with a diagnosis of mediastinitis who were included in the study and on mortality risk factors were obtained from the hospital database and then analyzed using SPPS 16.0 for Windows. Of the 19,767 patients undergoing open heart surgery, 117 [0.39%] had poststernotomy mediastinitis; 32% of these 117 died. The independent risk factors for mortality were methicillin-resistant Staphylococcus aureus [MRSA] [odds ratio [OR] 12.11 and 95% confidence interval [Cl] 3.15-46.47], intensive-care unit stays >48 h after the first operation [OR 11.21 and 95% Cl 3.24-38.84] and surgery that included valve replacement [OR 6.2 and 95% Cl 1.44-27.13]. The mortality rate decreased significantly, dropping from 38% [34/89] between 2004 and 2008 to 14% [4/28] between 2009 and 2012 [p = 0.018]. In this study, elimination of MRSA from the hospital setting decreased the rate of mortal-ity in patients with poststernotomy mediastinitis
ABSTRACT
We investigated the efficacy of pleural drainage with the use of different chest tube methods in patients after coronary artery bypass graft [CABG] surgery. Prospective randomized study of 60 patients undergoing elective on-pump single CABG surgery. The left internal mammary arterial grafts were harvested from all patients. The patients were separated into three groups: In one group [IC6, n=20], pleural tubes were inserted through the sixth intercostal space at the midaxillary line; in the second group [SX-r, n=20], rigid straight pleural tubes were inserted from the mediastinum through the subxiphoid area; and in the third group [SX-s, n=20], soft curved drainage tubes were inserted from the mediastinum through the subxiphoid area. The residual pleural effusion was examined by multislice CT scans within 8 hours of removal of the drainage tubes. Pain was evaluated according to standard methods. The groups did not differ with respect to volume of residual pleural effusion [P>.05]. The IC6 group had a higher mean pain score than the other two groups [P<.05], whose mean pain scores did not differ significantly from each other [P>.05]. IC6 group patients had a higher requirement for analgesics. The rate of atelectasis was higher in group IC6 [P<.05]. CT scans revealed that different chest tube insertion sites have the same efficiency for draining of pleural effusion, although drainage tubes inserted through the thoracic cage may result in more severe pain