Mediastinitis in pediatric cardiac surgery: treatment and cost-effectiveness in a low-income country.

Mediastinitis is a serious postoperative complication following pediatric cardiac surgery. The objective of this study is to evaluate the cost-effectiveness of surgical treatment for mediastinitis in Guatemala. All children who underwent a median sternotomy and developed postoperative mediastinitis between January 2004 and December 2005 were evaluated. Type of surgical treatment for mediastinitis, hospital outcome, and costs were analyzed. Eighteen (3.3%) of the 535 children who underwent a median sternotomy developed mediastinitis. Two patients underwent debridement of the infected tissues and delayed sternal closure, whereas 16 patients had debridement, primary chest closure, and continuous antibiotic irrigation of the mediastinum. All 11 patients who had the diagnosis of mediastinitis within 2 weeks after the operation survived. Three of the 7 patients (43%) who had delayed diagnosis died (p = 0.0003); all 3 had osteomyelitis (p = 0.0007). Primary closure with antibiotic irrigation was associated to a lower mortality rate and proved less expensive in comparison to delayed sternal closure (p = 0.003) mainly due to the shorter intensive care requirement. Debridement followed by primary closure of the chest and continuous antibiotic irrigation of the mediastinum seems to be a feasible and less expensive method to treat selected cases of postoperative mediastinitis in children.