Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982–2016)

Abstract Background Mediastinitis is a potentially fatal condition. In addition to timely diagnosis, its prognosis depends on an early and systematic approach. Objective To describe the results of mediastinitis treatment over a period of 34 years in a teaching hospital, its evolution and the current model of care. Materials and methods Cross-sectional, retrospective and descriptive study of patients with mediastinitis admitted from 1 June 1982 to 30 July 2016. The analysed variables were demographic, classification and aetiology of mediastinitis, comorbidities, complications, length of hospital and intensive care unit stay and mortality. Results 1880 patients were included of which 1496 (79.6%) were men. The mean age was 39.4 ± 17.8 years. According to the classification of Endo, 603 (32.1%) corresponded to type I and 1277 (67.9%) to types IIA and IIB. According to the aetiology, in 910 cases the origin was odontogenic (48.4%), 526 due to retropharyngeal abscess (28%), 147 secondary to submandibular abscess (7.8%), 49 due to cervical lymphadenectomy (2.6%), 36 due to pharyngeal trauma (1.9%), 14 due to post-intubation tracheal rupture (0.7%) and 198 were of undetermined origin (10.6%). Mediastinotomy with right thoracotomy was performed in 86% and mediastinotomy with left thoracotomy was performed in 14%. Simultaneous tracheostomy was performed in 83% of cases, standardising this procedure since 2005. Mortality varied between periods and was 50% in 1982–1992, 41% in 1992–2001, 35% in 2002–2011 and 17% in 2012–2016. Conclusion Along with the standardisation of the management of mediastinitis, a fall in mortality from this cause has been observed over the years. The maturity of the proposed model of care is a result of, among other things, medical and scientific advances and the experience gained in this pathology over more than three decades.