Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

Abstract

Results: On average, complication occurred within 13 days after operation; in a total of 25 lethal cases (2.4%), deaths occurred in eight (32%). Several risk factors for mediastinitis were identified as follows: 56% diabetes, 56% smoking, 20% obesity, 16% chronic obstructive pulmonary disease, and 8% end-stage renal disease. Mediastinitis was reported in 21 (84%) patients submitted to coronary artery bypass grafting and it was related to a major risk for development of infection (IC 3.44-8.30, P=0.0001). High rates of complications were observed: respiratory failure (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%), and sternal dehiscence (48%). Bacterial cultures of exudates were positive in 84% of patients; Staphylococcus aureus was the most frequently pathogen (28.8%) detected.Conclusion: Mediastinitis remains as a severe surgical complication and difficult to manage in postoperative cardiovascular surgery. The disease has low incidence rate but high lethality. Coronary bypass was associated to a major risk for development of infection.Descriptors: Infection. Mediastinitis. Cardiac surgical procedures.

Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients

“…Recent studies indicate that the male patient is more prone to develop mediastinitis and is an independent risk factor for its development [18][19][20]. In the present study, as well as that published by Sá et al [21], there was a higher incidence of mediastinitis in male patients. One of the probable mechanisms relates to the anatomy of man.…”

Preditores de infecção no pós-operatório de cirurgia de revascularização miocárdica

“…Specifically, the number of patients who developed deep wound infection was similar to that observed in other studies [7,8,14,[17][18][19][20][21], with some exceptions [22][23][24]. The expectation that new preventive and therapeutic approaches focusing on the prevention of surgical infection could reduce the incidence of infections over the past years did not occur in most of the studies cited, probably because more patients that underwent CABG during that period were elderly of high surgical risk and higher surgical complexity [25].…”

“…Similar results were observed by some authors [11], but not by others [12]. In Brazil, a recent study also shows a high incidence of postoperative mediastinitis in cardiac surgery [8].…”

“…Treatment for coronary artery bypass graft (CABG) has been shown to improve survival in patients with severe coronary artery disease [1]. However, several studies have shown, after heart surgery, still significant rate of postoperative complications, especially superficial and shallow infections [2][3][4][5][6][7][8]. A multicenter study conducted in Australia showed that of 4,474 patients undergoing CABG, the risk of wound infection was 4.5 to 10.7 per 100 procedures.…”

Critérios para realização de curativo em paciente com infecção de órgão/cavidade após cirurgia cardíaca

“…Trata-se de uma infecção profunda da ferida operatória com evidência clínica e/ou microbiológica do comprometimento do espaço retroesternal, associada à osteomielite, resultando em uma ferida complexa 2 .…”