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Risk Factors for Mediastinitis Following Median Sternotomy in Children

Kagen, Jessica BA*; Lautenbach, Ebbing MD, MPH, MSCE†‡§∥; Bilker, Warren B. PhD‡§∥; Matro, Jennifer BA*; Bell, Louis M. MD*¶; Dominguez, Troy E. MD#; Gaynor, J William MD**†; Shah, Samir S. MD, MSCE*‡§∥¶

Pediatric Infectious Disease Journal: July 2007 - Volume 26 - Issue 7 - pp 613-618
doi: 10.1097/INF.0b013e31806166bb
Original Studies

Background: Mediastinitis is a devastating complication of pediatric cardiothoracic surgery. However, risk factors for the development of mediastinitis are poorly characterized. The objective of this study was to identify risk factors for mediastinitis in a cohort of children undergoing cardiothoracic surgery at a tertiary care children's hospital.

Methods: This case-control study included patients who underwent median sternotomy between January 1, 1995 and December 31, 2003. Univariate analyses, logistic regression, and multinomial regression were performed to determine the association between potential risk factors and the development of mediastinitis.

Results: Forty-three patients with mediastinitis and 184 patients without mediastinitis were included. One hundred and twelve (49%) patients were female. The median patient age was 128 days (interquartile range: 7 days–2.0 years). A known or possible genetic syndrome was present in 53 (24%) patients. The following factors were associated with the development of mediastinitis: presence of a known or possible genetic syndrome (adjusted odds ratio, OR: 4.5; 95% confidence interval, CI: 1.8–11.4); American Society of Anesthesiologists score >3 (adjusted OR: 3.4; 95% CI: 1.1–10.3); and presence of intracardiac pacing wires for >3 days (adjusted OR: 15.8; 95% CI: 2.0–127.2).

Conclusions: The presence of a known or possible genetic syndrome, American Society of Anesthesiologists score >3, and the presence of intracardiac pacing wires for >3 days were each associated with the development of mediastinitis in children after median sternotomy.

From the Divisions of *Infectious Diseases, and **Cardiothoracic Surgery, The Children's Hospital of Philadelphia; and the Departments of ¶Pediatrics, †Medicine, ††Surgery, #Anesthesia and Critical Care, ‡Biostatistics and Epidemiology, and the §Centers for Education and Research on Therapeutics, and the ∥Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.

Accepted for publication March 22, 2007.

Address for correspondence: Samir Shah, MD, Division of Infectious Diseases, Room 1526, North Campus, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. E-mail: shahs@email.chop.edu.

© 2007 Lippincott Williams & Wilkins, Inc.