Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis
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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/21/6364 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Maria Teresa Congedo |
| collection | DOAJ |
| description | 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 (<i>p</i>:0.031), cervicotomy alone as surgical approach (<i>p</i> = 0.040), and the bilateral approach (<i>p</i> = 0.048) resulted in significance in terms of the univariate analysis; age ≥ 60 years (<i>p</i> = 0.04) and cervical approach (<i>p</i> = 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. |
| first_indexed | 2024-03-09T18:57:52Z |
| format | Article |
| id | doaj.art-9bf3316a01e245238f6dc8bb7bd87eb4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T18:57:52Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-9bf3316a01e245238f6dc8bb7bd87eb42023-11-24T05:16:29ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011121636410.3390/jcm11216364Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing MediastinitisMaria Teresa Congedo0Dania Nachira1Mariano Alberto Pennisi2Marco Chiappetta3Giuseppe Calabrese4Giuseppe Bello5Claudio Parrilla6Laura Franza7Marcello Covino8Leonardo Petracca Ciavarella9Venanzio Porziella10Maria Letizia Vita11Filippo Lococo12Stefano Margaritora13Elisa Meacci14Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyUnit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyBackground: 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 (<i>p</i>:0.031), cervicotomy alone as surgical approach (<i>p</i> = 0.040), and the bilateral approach (<i>p</i> = 0.048) resulted in significance in terms of the univariate analysis; age ≥ 60 years (<i>p</i> = 0.04) and cervical approach (<i>p</i> = 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.https://www.mdpi.com/2077-0383/11/21/6364descending necrotizing mediastinitiscervical abscesssurgerythoracoscopy |
| spellingShingle | 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 Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis Journal of Clinical Medicine descending necrotizing mediastinitis cervical abscess surgery thoracoscopy |
| title | Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis |
| title_full | Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis |
| title_fullStr | Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis |
| title_full_unstemmed | Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis |
| title_short | Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis |
| title_sort | risk factors associated with post operative complications in multidisciplinary treatment of descending necrotizing mediastinitis |
| topic | descending necrotizing mediastinitis cervical abscess surgery thoracoscopy |
| url | https://www.mdpi.com/2077-0383/11/21/6364 |
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