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(Chest. 2003;124:1847-1851.)
© 2003 American College of Chest Physicians

Autotransfusion of Shed Mediastinal Blood*

A Risk Factor for Mediastinitis After Cardiac Surgery? Results of a Cluster Investigation

Sandra Dial, MD, MSc; Dao Nguyen, MD and Dick Menzies, MD, MSc

* From the Respiratory Epidemiology Unit (Dr. Menzies), Montreal Chest Institute, McGill University, Montreal; Department of Critical Care (Dr. Dial), Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal; and Respiratory Division (Dr. Nguyen), McGill University Health Centre, McGill University, Montreal, Canada.

Correspondence to: Sandra Dial, MD, MSc, Montreal Chest Institute, 3650 St. Urbain, Room K3.02, Montreal, PQ, Canada, H2X 2P4; e-mail: sandra.dial{at}mcgill.ca

Rationale: After the introduction of autotransfusion of shed mediastinal blood following cardiac surgery, the incidence of mediastinitis increased. The role of autotransfusion in the increased occurrence of this serious complication was examined.

Methods: Using a case-control design, the preoperative, intraoperative, and postoperative characteristics of 11 patients with mediastinitis were compared to those of 33 randomly selected patients undergoing cardiac surgery between September 1, 2000, and April 15, 2001 (control subjects).

Results: Patients with mediastinitis were significantly more likely to have a body mass index > 30 (unadjusted odds ratio [OR], 9.9; 95% confidence interval [CI], 2.3 to 42.5), to have received antibiotic therapy during the 2 weeks prior to cardiac surgery (OR, 12.0; 95% CI, 1.1 to 131), or to have required re-exploration within 24 h of the original operation (OR, 8.3; 95% CI, 1.8 to 39). Patients with mediastinitis had 3.4 known risk factors for mediastinitis, compared to only 1.4 risk factors per control subject (p = 0.0001), and longer duration of autotransfusion. After adjustment for other risk factors, autotransfusion for > 6 h was significantly associated with the development of mediastinitis (adjusted OR, 11.9; 95% CI, 1.4 to 97.2).

Conclusion: Retransfusion of shed mediastinal blood for > 6 h after cardiac surgery was an independent risk factor for mediastinitis.

Key Words: autotransfusion • cardiac surgery • deep sternal wound infections • mediastinitis • postoperative complications






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