10-Year Follow-up of Patients With and Without Mediastinitis John H. Braxton, MD, Charles A.S. Marrin, M.B., BS, Paul D. McGrath, MD, Jeremy R. Morton, MD, Mitchell Norotsky, MD, David C. Charlesworth, MD, Stephen J. Lahey, MD, Robert Clough, MD, Cathy S. Ross, MS, Elaine M. Olmstead, and Gerald T. O’Connor, PhD for the Northern New England Cardiovascular Disease Study Group Mediastinitis is a dreaded complication of CABG surgery. Short-term outcomes have been described, but there have been only a few long-term studies. We examined the survival of patients undergoing isolated CABG surgery between 1992 and 2001. Mediastinitis was identified during the index admis- sion. Proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI 95%). Among 36,078 consecutive patients, there were 5749 deaths during 148,319 person years of follow-up. There were 418 cases of mediastinitis (1.16%). The incidence of death was 11.15 per 100 person/years with mediastinitis and 3.81 deaths/100 person years without. (P < 0.001). We also examined the mortality rates of patients who survived at least 6 months after their CABG surgery. Patients with mediastinitis had an incidence rate of 5.70 deaths per 100 person/years while those without had a rate of 2.66 deaths per 100 person/years (P < 0.001). After adjustment for baseline differences in patient and disease characteristics, the hazard ratio was 2.12 (CI95%  1.86, 2.58; P < 0.001). The adjusted hazard ratios for patients who survived 6 months postsurgery was 1.70 (CI95%  1.36, 2.13; P < 0.001). Mediastinitis is associated with a marked increase in both acute and long-term mortality rates. © 2004 Elsevier Inc. All rights reserved. Key words: Mediastinitis, survival, coronary artery surgery. M ediastinitis is a serious complication of cor- onary artery bypass grafting (CABG). The incidence of mediastinitis has been reported to be between 1% and 4%. 1-4 This complication contin- ues to have a dramatic impact on patient out- comes, with a reported hospital mortality rate between 10% and 20%. 5-7 The etiology of medias- tinitis is complex, and many patient and proce- dural risk factors have been identified. 5-7 Short-term results have been described and have improved with aggressive management. 5,7 Long-term results have been described only re- cently. 1,8,9 Loop and coworkers suggested that mediastinitis has negative long-term conse- quences, and a recent report described the neg- ative impact on two-year survival. 1,8 The Northern New England Cardiovascular Disease Study Group (NNECDSG) is a voluntary research consortium composed of clinicians, re- search scientists, and hospital administrators. The goal of the group is to foster the continuous improvement in the quality of clinical care through the analysis of process and outcome data and the timely feedback of data. The NNECDSG recently reported long-term results describing 4-year survival. 9 This study builds on our previous analysis by extending the follow-up period to 10 years (1992-2001) and differentiating between the acute and long-term consequence of medias- tinitis. From the Maine Medical Center, Portland, ME, Dartmouth- Hitchcock Medical Center, Lebanon, NH, Fletcher-Allen Health Cen- ter, Burlington, VT, Catholic Medical Center, Manchester, NH, Uni- versity of Massachusetts, Worcester, MA, Eastern Maine Medical Center, Bangor, ME, and Dartmouth Medical School, Center for the Evaluative Clinical Sciences, Hanover, NH. This research was supported in part by a grant from the American Heart Association (9970047N). Address reprint requests to John H. Braxton, MD, Maine Heart Surgical Associates, 7 Bramhall Street, Portland, ME. © 2004 Elsevier Inc. All rights reserved. 1043-0679/04/1601-0011$30.00/0 doi:10.1053/j.semtcvs.2004.01.006 70 Seminars in Thoracic and Cardiovascular Surgery, Vol 16, No 1 (Spring), 2004: pp 70-76