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Mortality Trends and the Effects of Débridement Timing in the Management of Mediastinitis in the United States, 1998 to 2010

Aliu, Oluseyi M.D., M.S.; Diaz-Garcia, Rafael J. M.D.; Zhong, Lin M.D., M.P.H.; McGlinn, Evan B.S.; Chung, Kevin C. M.D., M.S.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 457e–463e
doi: 10.1097/PRS.0000000000000422
Reconstructive: Trunk: Original Articles
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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.

Ann Arbor, Mich.

From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.

Received for publication November 4, 2013; accepted March 13, 2014.

Disclosures: The authors have no financial interest to declare in relation to the content of this article.

Kevin C. Chung, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, Mich. 48109-0340, kecchung@med.umich.edu

©2014American Society of Plastic Surgeons