Risk factors for mediastinitis and sternal dehiscence after cardiac surgery

INTRODUCTION AND OBJECTIVES: The aim of our study was to identify risk factors for the development of post-sternotomy mediastinitis and sternal dehiscence without infection. PATIENTS AND METHOD: The records of all patients who presented with sternal abnormalities between January 1, 1997 and December 31, 2003 were reviewed retrospectively, and potential risk factors were examined. Patients were divided into three groups: group A had mediastinitis; group B had sternal dehiscence; and group C served as a control group. Multivariate analysis was carried out and the three groups were compared using the Kruskal-Wallis test. RESULTS: The incidence of mediastinitis was 0.34% and that of sternal dehiscence without mediastinitis was 0.55%. The main risk factors for mediastinitis were postoperative pneumonia (P=.006), urinary tract infection (P=.02), and use of intra-aortic balloon counterpulsation (P=.027). Risk factors for sternal dehiscence without infection were age >60 years (P=.01), postoperative pneumonia (P=.003), antiplatelet agent use (P=.006), and beta-blocker use (P=.0001). CONCLUSIONS: The incidences and risk factors for mediastinitis and sternal dehiscence were different in this series. Postoperative pneumonia was the only risk factor common to the two conditions.