Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis

Maria Teresa Congedo, Dania Nachira, Mariano Alberto Pennisi, Marco Chiappetta, Giuseppe Calabrese, Giuseppe Bello, Claudio Parrilla, Laura Franza, Marcello Covino, Leonardo Petracca Ciavarella, Venanzio Porziella, Maria Letizia Vita, Filippo Lococo, Stefano Margaritora, Elisa Meacci

Research output: Contribution to journalArticle

Abstract

Background: Descending necrotizing mediastinitis (DNM) is a severe, life-threatening complication of oropharyngeal infections with cervical necrotizing fasciitis. In this study, we aimed to identify any possible factors that correlate with favorable outcomes. Methods: We retrospectively analyzed our series of 18 patients who underwent surgical treatment for DNM from a cervical abscess. Gender, age, symptoms, etiopathogenesis, comorbidities, time to surgery from diagnosis, degree of diffusion, identified microorganisms, surgical procedure, days in the intensive care unit, need for tracheostomy, complications, and surgical outcomes were reviewed. Results: The main type of surgery was thoracotomy + cervicotomy in eight cases (50.0%), followed by cervicotomy +VATS in four (22.2%). Seven patients (38.9%) had two or more surgeries; a bilateral operation was necessary for four patients. Evaluating the risk factors associated with post-operative complications, age ≥ 60 years (p:0.031), cervicotomy alone as surgical approach (p = 0.040), and the bilateral approach (p = 0.048) resulted in significance in terms of the univariate analysis; age ≥ 60 years (p = 0.04) and cervical approach (p = 0.05) maintained their significance in terms of the multivariate analysis. Conclusions: The low mortality of our series emphasizes the importance of an extensive and immediate surgical drainage of both the neck and the mediastinum. Mediastinal drainage from cervicotomy seems to be a risk factor for post-operative complications. Minimally invasive surgery on the chest cavity, such as with Uniportal-VATS, could be a good approach above all in elderly patients and all those cases where bilateral access is required.
Original languageEnglish
Pages (from-to)N/A-N/A
JournalJournal of Clinical Medicine
Volume11
DOIs
Publication statusPublished - 2022

Keywords

  • cervical abscess
  • descending necrotizing mediastinitis
  • surgery
  • thoracoscopy

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