Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

Acute mediastinitis is a life-threatening situation that is associated with high rates of morbidity and mortality. The most common causes of mediastinitis are: oesophageal perforation, acute necrotising mediastinitis (ANM) and post-sternotomy mediastinitis. The aim of this study was to analyze prognostic factors and the differences between mediastinitis from various origins. A retrospective analysis was carried out on all patients operated on for acute mediastinitis between 2000 and 2009. Surgical interventions were performed on 33 patients (69.7% male), the majority as a consequence of oesophageal perforation (21 cases). The overall mortality rate was 30%. Better survival was seen in subjects less than 60 years of age, subjects with no comorbidities, and subjects who had undergone early tracheotomy. Patients with ANM were younger, had less comorbidities, diagnosed later and required more repeat interventions compared to those patients who had mediastinitis caused by oesophageal perforations. Mortality was lower in the ANM group, but this was not statistically significant. Protective factors in mediastinitis are: early diagnostic and treatment, age under 60 years, absence of major comorbidity and early tracheotomy.