Development and External Validation of a Predictive Score of Postoperative Mediastinitis in Cardiovascular Surgery Derived from the CONAREC XVI Multicenter Registry

Ignacio Nogues, María Sol Donato, María Jimena Gambarte, Graciana María Ciambrone, Julio Giorgini, Diego Lowenstein, Victorio Carosella, Carlos Nojek, Claudio C. Higa


Objective: The aim of this analysis was to define independent predictive variables for the development of mediastinitis after cardiovascular surgery and develop a validated score to stratify the risk for mediastinitis.

Methods: Data were retrieved from the CONAREC XVI study comprising adults undergoing cardiovascular surgery between September 2007 and October 2008 in 49 centers of 16 provinces in Argentina. Mediastinitis was defined as the presence of clinical signs attributable to the condition or positive cultures. Epidemiological and clinical variables, type of surgery, intraoperativeand postoperative variables and complementary tests were evaluated. A logistic regression model was used toidentify the independent variables associated with perioperative mediastinitis. A two-tailed alpha error < 0.05 was consideredstatistically significant. A score was constructed and was externally validated in patients from other surgical centers.

Results: A total of 2553 patients were analyzed: coronary artery bypass graft surgery, 1465 patients (57.4%); aortic valve replacement,359 (14.1%); mitral valve surgery, 169 (6.6%); combined procedure (revascularization-valve surgery), 312 (12.2%); other procedures, 248 (9.7%). The overall incidence of medistinitis was 1.88%. The variables associated with the development of mediastinitis were: smoking habits (OR, 2.3; 95% CI,1.1-5,1; p=0.02), severe left ventricular dysfunction (OR, 2.8; 95% CI,1.3-6.2; p=0.001), reoperation (OR, 4,6; 95% CI,1.8-11.3; p=0.01) and postoperative renal failure (OR, 4.3; 95% CI, 1.9-9,6;p=0.0001). A risk score was constructed assigning 1 point for severe left ventricular dysfunction, 1 point for the history of smoking habits, 2 points for the development of renal failure and 2 points for need for reoperation. The area under the ROC curve for mortality was 0.72 (95% CI, 0.64-0,81; Hosmer Lemeshow test p=0.9). The external validation was performed on1657 patients, mean age 62.8±13.3 years. The incidence of mediastinitis was 1.6%. The area under the ROC curve for the development of mediastinitis was 0.70 (95% CI, 0.58-0.80; p=0.001).

Conclusions: The construction of a predictive score for the development of postoperative mediastinitis after cardiovascular surgery is relevant for daily practice for the prevention and early detection of this severe complication.


Eklund AM, Lytikäinen O, Klemets P, Huotari K, Anttila VJ, Werkkala KA, et al. Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg 2006;82:1784-9.

Barbosa TM, Sgarbieri RN, Moreira Neto FF, Vieira FF, Pereira Gde A, de Rezende Filho AV, Capuci HH, Meirelles R. Evaluation of the NNECDSG Score in a Brazilian public hospital. Rev Bras Cir Cardiovasc 2007;22:212-7.

O'Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. JAMA 1991;266:803-9.

Magedanz EH, Bodanese LC, Guaragna JC, Albuquerque LC, Martins V, Minossi SD, et al. Risk score elaboration for mediastinitis after coronary artery bypass grafting. Rev Bras Cir Cardiovasc 2010;25:154-9.

Lowenstein Haber DM, Guardiani FM, Pieroni P, Pfister L, Carrizo L, Villegas ED, et al. Realidad de la cirugía cardíaca en la República Argentina. Rev Argent Cardiol 2010;78:228-37.

Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection. Ann Surg 2003;238:1-5.

Gravante G, Araco A, Sorge R, Araco F, Delogu D, Cervelli V, et al. Wound infections in body contouring mastopexy with breast reduction after laparoscopic adjustable gastric bandings: The role of smoking. Obes Surg 2008;18:721-7.

Gravante G, Araco A, Sorge R, Araco F, Delogu D, Cervelli V, et al. Wound infections in post-bariatric patients undergoing body contouring abdominoplasty: The role of smoking. Obes Surg 2007;17:1325-31.

Pompeu Barros de Oliveira Sá M, Oliveira Silva D, Nibbering de Souza E, de Carvalho R, Vasconcelos F, Gonçalves de Rueda F, et al. Postoperative mediastinitis in cardiovascular surgery. Analysis of 1038 consecutive surgeries. Rev Bras Cir Cardiovasc 2010;25:19-24.

Black CE, Huang N, Neligan PC, Levine RH, Lipa JE, Lintlop S, et al. Effect of nicotine on vasoconstrictor and vasodilator responses in human skin vasculature. Am J Physiol Regul Integr Comp Physiol 2001;281:1097-104.

Dintenfass L. Elevation of blood viscosity, aggregation of red cells, haematocrit values, and fibrinogen levels with cigarette smokers. Med J Aust 1975;1:617-20.

Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204:1178-87.

Thakar CV, Yared JP, Worley S, Cotman K, Paganini EP. Renal dysfunction and serious infections after open-heart surgery. Kidney Int 2003;64:239-46.

Tang GH, Maganti M, Weisel RD, Borger MA. Prevention and management of deep sternal wound infection. Semin Thorac Cardiovasc Surg 2004;16:62-9.

Diez C, Koch D, Kuss O, Silber RE, Friedrich I, Boergermann J. Risk factors for mediastinitis after cardiac surgery – a retrospective analysis of 1700 patients. J Cardiothorac Surg 2007;2:23.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020