Is Early Tracheostomy a Risk Factor for Mediastinitis after Median Sternotomy?

Abstract

Early tracheostomy may increase the risk of mediastinitis after median sternotomy. Patients who had postoperative tracheostomy after cardiac surgery in the period 2000-2005 were retrospectively analyzed (total: 5095 patients) to evaluate the incidence of mediastinitis and sternal wound infections. Fifty-seven cases (1.1% of all operated patients) had postoperative tracheostomy at an average 5.6 +/- 0.7 days postoperatively. None of these patients had mediastinitis. Eleven cases of aseptic sternal instability and ten cases of mild-to-moderate infection limited to subcutaneous planes were observed. There was no correlation between the time to performance of tracheostomy and the isolation of bacteria from the thoracic wounds (p = 0.61). The bacterial strains isolated from subcutaneous infection were qualitatively and quantitatively different from those isolated from bronchial secretions. We conclude that in this study there is no demonstrable link between early tracheostomy after sternotomy and mediastinitis. Early tracheostomy should not be denied due to concerns of increasing the risk of mediastinitis.

Infectious Complications of Cardiac Surgery: A Clinical Review

“…A host of independent risk factors have been identified for sternal site infections (Table 1). 22,26-30 Of these, cardiogenic shock, long perfusion times, and intra-aortic counterpulsation devices are the most strongly associated with infection. However, obesity, diabetes, smoking, blood transfusions, and cardiac failure also have been identified as important risk factors because of their frequency and the fact that they can be modified by thorough preoperative screening and the initiation of preventative measures (see prevention section).…”

The association between tracheostomy and sternal wound infection in postoperative cardiac surgery patients

“…Tracheostomy prior to any identified SWI occurred in 411 patients (2.2%), and the median [IQR] time from post-surgical ICU admission to tracheostomy was 14 [10][11][12][13][14][15][16][17][18][19] Table 2. Tracheostomy was an independent predictor of SWI (adjusted OR 2.8; 95% CI 1.9 to 4.2).…”

“…There continues to be uncertainty as to the true nature of the relationship between tracheostomy and SWI, with recent publications both supporting and refuting tracheostomy as a cause of SWI post cardiac surgery. [5][6][7][8][9][10][11] Three large observational studies support tracheostomy as a risk factor for SWI. In a study of 6,057 patients undergoing isolated coronary artery bypass, Curtis et al 5 Two previous studies that failed to detect an association between tracheostomy and SWI were limited by small numbers of events, which precluded robust risk adjustment.…”

Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

“…2 Another controversial point is whether it is ideal to carry out a tracheotomy in those patients in whom intubation seems to be difficult, or who look likely to require mechanical ventilation for a long period of time. Tracheotomy was carried out in 6 patients (all 18 in which 5095 operated patients were analysed in order to evaluate the incidence of mediastinitis and sternal infection in patients who had undergone post-operative tracheotomy. Of these 5095 patients, tracheotomy was carried out in 57 cases and mediastinitis did not occur in a single one; moreover, no increase in the incidence of cases of bacterial growth in the sternum was observed (P=0.61).…”