Mortality trends and the effects of débridement timing in the management of mediastinitis in the United States, 1998 to 2010.

BACKGROUND: The authors examined the relationship between débridement delay and mortality for mediastinitis patients. The authors also assessed mortality trends for mediastinitis patients between 1998 and 2010.

METHODS: The authors conducted a retrospective cross-sectional study with data from the Nationwide Inpatient Sample, 1998 to 2010. They studied adult patients, 18 years of age or older, who were surgically treated for mediastinitis. They used a logistic regression model adjusted for patient demographic and clinical characteristics to evaluate the association between timing of first operative débridement and in-hospital mortality. Using their logistic model, they calculated the adjusted probability of in-hospital mortality for each year of the study.

RESULTS: Results showed that initial débridement after the fourth day of admission increased the odds of in-hospital mortality by 50 percent (odds ratio, 1.5; 95 percent confidence interval, 1.0 to 2.1). In addition, the adjusted probability of in-hospital mortality for an average patient treated for mediastinitis decreased from 10.6 percent in 1998 to 3.1 percent in 2010.

CONCLUSION: There is a survival advantage from timely initial débridement in mediastinitis patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.