Clinical characteristics and outcomes of 176 patients with acute necrotizing mediastinitis: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Linchuan , PENG Zhiyu , LIN Huahang , ZHOU Ke ,  MEI Jiandong

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

MEI Jiandong, Email: jiandongmei@aliyun.com

Keywords：

Acute necrotizing mediastinitis; clinical characteristics; etiology; surgery; outcomes

DOI：

10.7507/1007-4848.202309011

Video：

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Objective To investigate the etiology, symptoms, diagnosis, surgical treatment, and outcomes of acute necrotizing mediastinitis (ANM) in order to guide future diagnosis and treatment of ANM. Methods The clinical data of patients with ANM referred to West China Hospital, Sichuan University from March 2012 to April 2021 were retrospectively analyzed. The etiology, clinical manifestations, demographic characteristics, bacterial culture results, surgical approach and prognostic factors of these patients were summarized. Results A total of 176 patients were enrolled in this study. The median age was 60 ( 0-84) years. There were 124 (70.5%) males and 52 (29.5%) females. The most common origin of infection was neck (n=66, 37.5%). The most common symptom was fever (n=85, 48.3%). Streptococcus constellatus represented the most common pathogens in secretion culture. Surgical treatment was administered to 119 (67.6%) patients through different approaches, including 54 (30.7%) patients of cervical approach, 9 (5.1%) patients of thoracotomy, 18 (10.2%) patients of video-assisted thoracoscopic surgery (VATS), 7 (4.0%) patients of cervical combined with thoracotomy, 30 (17.0%) patients of cervical combined with VATS, and 1 (0.6%) patient of subxiphoid approach. Among this cohort, 144 (81.8%) patients were cured, while 32 (18.1%) patients died. Age-adjusted Charlson comorbidity index (OR=2.95, P=0.022), perioperative sepsis (OR=2.84, P=0.024), and non-surgical treatment (OR=2.41, P=0.043) were identified as independent predictors of poor outcomes. Conclusion For patients with corresponding history and manifestations of ANM, it is crucial to go through imaging examination to confirm the presence of an abscess and guide the selection of surgical approach. Once the diagnosis of ANM is made, it is imperative to promptly perform surgical intervention for effective drainage. Our study highlights the significance of age-adjusted Charlson comorbidity index, perioperative sepsis and surgical treatment in predicting patients’ outcomes.

Citation： LIANG Linchuan, PENG Zhiyu, LIN Huahang, ZHOU Ke, MEI Jiandong. Clinical characteristics and outcomes of 176 patients with acute necrotizing mediastinitis: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 243-248. doi: 10.7507/1007-4848.202309011 Copy

1.	Estrera AS, Landay MJ, Grisham JM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet, 1983, 157(6): 545-552.
2.	Pearse HE. Mediastinitis following cervical suppuration. Ann Surg, 1938, 108(4): 588-611.
3.	Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck, 2016, 38(Suppl 1): E2275-E2283.
4.	Brajkovic D, Zjalic S, Aleksandar K. Evaluation of clinical parameters affecting the prognosis in surgically treated patients with descending necrotizing mediastinitis - A retrospective study. J Stomatol Oral Maxillofac Surg, 2022, 123(6): e731-e737.
5.	Congedo MT, Nachira D, Pennisi MA, et al. Risk factors associated with post-operative complications in multidisciplinary treatment of descending necrotizing mediastinitis. J Clin Med, 2022, 11(21): 6364 .
6.	Wang M, Li S, Zheng T, et al. Big data health care platform with multisource heterogeneous data integration and massive high-dimensional data governance for large hospitals: Design, development, and application. JMIR Med Inform, 2022, 10(4): e36481.
7.	Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol, 1994, 47(11): 1245-1251.
8.	Abu-Omar Y, Kocher G J, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg, 2017, 51(1): 10-29.
9.	Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med, 2017, 43(3): 304-377.
10.	Endo S, Murayama F, Hasegawa T, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg, 1999, 47(1): 14-19.
11.	Guan X, Liang X, Liang X, et al. A new classification of descending necrotizing mediastinitis and surgical strategies. Ann Transla’ Med, 2021, 9(4): 356.
12.	Sugio K, Okamoto T, Maniwa Y, et al. Descending necrotizing mediastinitis and the proposal of a new classification. JTCVS open, 2021, 8: 633-647.
13.	Nhat LX, Vinh VH, Thi CP, et al. Surgical management of descending necrotizing mediastinitis: Strategy for thoracic interference. J Cardiothorac Surg, 2023, 18(1): 229.
14.	Saito Y, Komaru S. Video-assisted thoracoscopic surgery for a pediatric patient with descending necrotizing mediastinitis. Transl Pediatr, 2022, 11(9): 1435-1437.
15.	Tanaka Y, Maniwa Y, Sugio K, et al. The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis. Interdiscip Cardiovasc Thorac Surg, 2023, 36(4): ivad053.
16.	Wu P, Ye F, Zhang Z, et al. Descending necrotizing mediastinitis: Analysis of 9 patients in our hospital. Ear Nose Throat J, 2021, 100(5): 350-353.
17.	倪茂美, 杨秀海. 颈深部合并上纵隔感染的临床诊疗分析. 临床耳鼻咽喉头颈外科杂志,2016, 30(10): 801-804.
18.	Palma DM, Giuliano S, Cracchiolo AN, et al. Clinical features and outcome of patients with descending necrotizing mediastinitis: Prospective analysis of 34 patients. Infection, 2016, 44(1): 77-84.
19.	Roccia F, Pecorari G C, Oliaro A, et al. Ten years of descending necrotizing mediastinitis: Management of 23 patients. J Oral Maxillofac Surg, 2007, 65(9): 1716-1724.
20.	Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Crit Care Med, 2021, 49(11): e1063-e1143.
21.	Freeman RK, Vallières E, Verrier E D, et al. Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg, 2000, 119(2): 260-267.
22.	Chen KC, Chen JS, Kuo SW, et al. Descending necrotizing mediastinitis: A 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg, 2008, 136(1): 191-198.
23.	Gaber Hassanein A, Mohamed EEH, Hazem M, et al. Assessment of prognosis in odontogenic descending necrotizing mediastinitis: A longitudinal retrospective study. Surg Infect (Larchmt), 2020, 21(8): 709-715.

1. Estrera AS, Landay MJ, Grisham JM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet, 1983, 157(6): 545-552.
2. Pearse HE. Mediastinitis following cervical suppuration. Ann Surg, 1938, 108(4): 588-611.
3. Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck, 2016, 38(Suppl 1): E2275-E2283.
4. Brajkovic D, Zjalic S, Aleksandar K. Evaluation of clinical parameters affecting the prognosis in surgically treated patients with descending necrotizing mediastinitis - A retrospective study. J Stomatol Oral Maxillofac Surg, 2022, 123(6): e731-e737.
5. Congedo MT, Nachira D, Pennisi MA, et al. Risk factors associated with post-operative complications in multidisciplinary treatment of descending necrotizing mediastinitis. J Clin Med, 2022, 11(21): 6364 .
6. Wang M, Li S, Zheng T, et al. Big data health care platform with multisource heterogeneous data integration and massive high-dimensional data governance for large hospitals: Design, development, and application. JMIR Med Inform, 2022, 10(4): e36481.
7. Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol, 1994, 47(11): 1245-1251.
8. Abu-Omar Y, Kocher G J, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg, 2017, 51(1): 10-29.
9. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med, 2017, 43(3): 304-377.
10. Endo S, Murayama F, Hasegawa T, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg, 1999, 47(1): 14-19.
11. Guan X, Liang X, Liang X, et al. A new classification of descending necrotizing mediastinitis and surgical strategies. Ann Transla’ Med, 2021, 9(4): 356.
12. Sugio K, Okamoto T, Maniwa Y, et al. Descending necrotizing mediastinitis and the proposal of a new classification. JTCVS open, 2021, 8: 633-647.
13. Nhat LX, Vinh VH, Thi CP, et al. Surgical management of descending necrotizing mediastinitis: Strategy for thoracic interference. J Cardiothorac Surg, 2023, 18(1): 229.
14. Saito Y, Komaru S. Video-assisted thoracoscopic surgery for a pediatric patient with descending necrotizing mediastinitis. Transl Pediatr, 2022, 11(9): 1435-1437.
15. Tanaka Y, Maniwa Y, Sugio K, et al. The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis. Interdiscip Cardiovasc Thorac Surg, 2023, 36(4): ivad053.
16. Wu P, Ye F, Zhang Z, et al. Descending necrotizing mediastinitis: Analysis of 9 patients in our hospital. Ear Nose Throat J, 2021, 100(5): 350-353.
17. 倪茂美, 杨秀海. 颈深部合并上纵隔感染的临床诊疗分析. 临床耳鼻咽喉头颈外科杂志,2016, 30(10): 801-804.
18. Palma DM, Giuliano S, Cracchiolo AN, et al. Clinical features and outcome of patients with descending necrotizing mediastinitis: Prospective analysis of 34 patients. Infection, 2016, 44(1): 77-84.
19. Roccia F, Pecorari G C, Oliaro A, et al. Ten years of descending necrotizing mediastinitis: Management of 23 patients. J Oral Maxillofac Surg, 2007, 65(9): 1716-1724.
20. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Crit Care Med, 2021, 49(11): e1063-e1143.
21. Freeman RK, Vallières E, Verrier E D, et al. Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg, 2000, 119(2): 260-267.
22. Chen KC, Chen JS, Kuo SW, et al. Descending necrotizing mediastinitis: A 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg, 2008, 136(1): 191-198.
23. Gaber Hassanein A, Mohamed EEH, Hazem M, et al. Assessment of prognosis in odontogenic descending necrotizing mediastinitis: A longitudinal retrospective study. Surg Infect (Larchmt), 2020, 21(8): 709-715.

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Clinical characteristics and outcomes of 176 patients with acute necrotizing mediastinitis: A retrospective cohort study

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