Evolution of postsurgical mediastinitis after Major Heart Surgery (MHS) in the last 12 years: Are we improving?

Abstract

Background: Postsurgical mediastinitis (PSM) is a serious and potentially life-threatening complication of Major Heart Surgery (MHS). Data on the evolution of the incidence of PSM after MHS in large series of operated patients in recent years are scarce. The aim of our study was to evaluate the trend of incidence, microbial etiology, and associated mortality of PSM at a referral MHS unit in the last 12 years.

Material and methods: The study was conducted at a tertiary hospital in Madrid, Spain. We carried out a retrospective and cross-sectional study that included all patients who underwent CCM and developed MPQ between January 2012 and December 2023 at our institution. It was conducted at a tertiary hospital in Madrid, Spain. We carried out a retrospective and cross-sectional study that included all patients who underwent CCM and developed MPQ between January 2012 and December 2023 at our institution.

Results: During the 12-year study period, a total of 5,584 patients underwent MHS at our institution. The incidence rate of PSM varied yearly between 1.16 and 2.34 episodes/100 surgical procedures. Overall, the 89 patients with PSM were analyzed (92 different episodes). Their median age was 67 years (IQR 56-75) and most of them were male (63%). Their median Euroscore was 7 (IQR 5-9.5). Main type of heart surgery in patients with PSM was: coronary artery bypass graft in 37% and valve replacement in 32.6%. The more frequent causative microorganisms were: Gram-positive bacteria (59.0%), Gram-negative bacteria (32.4%), fungi (7.6%) and others (1%). Overall, 22 patients died (24.7%).

Conclusions: The incidence of PSM has remained stable and below 2.5% in the last 12 years in our institution, but it continues to be an entity associated with high morbidity and mortality and long hospital stays.