[Mediastinis related to esophagogastric disease and injury. Warning clinical signs and independent predictors of intrahospitalary survival].

OBJECTIVE: To identify clinical warning signs and independent predictors of survival in mediastinitis related to esophagogastric diseases and injuries.
METHODS: From March 1998 to February 2009, 36 patients with a mean age of 55.7 +/- 12.3 years old, with mediastinitis due to esophagogastric diseases and injuries were treated. Signs present before diagnosis of mediastinitis were identified. Several presentation and evolutive variables were confronted with mortality and survival.
RESULTS: Mortality was 41.7%. Three etiological groups were discriminated: 1) 21 postoperatives of esophagogastric surgery with 57.1% mortality, 2) 14 instrumental and foreign bodies perforations of esophagus with 14.3% mortality, 3) 1 esophageal cancer perforation with no survival. Warning signs in group 1 were: bad postoperative evolution with sepsis and no other septic focus, septic pleural effusion, neumothorax, and supraventricular tachyarrhythmia. Warning signs in group 2 were: thorax pain usually retrosternal, pneumomediastinum, prevertebral cervical and subcutaneous emphysema, pleural effusion, sepsis, and odynophagia. Independent predictors of survival were: surgical procedure tactics that prioritizes debridement with mediastinal, pleural and neck drainage, esophagostomy and gastrostomy in opposition to less aggressive surgical tactics [OR 12.6 (95% CI: 1.7-66.5)], and surgery within the 24 hs of noticing the warning signs [OR 10.6 (95% CI: 1.7-96.7)]. These survival predictors were at the expense of group 1. Group 2 did not show any predictor of survival.
CONCLUSIONS: In mediastinitis involving esophagogastric surgery, we recommend to apply the surgical tactics delineated previously and perform surgery within the 24 hs of noticing the warning signs. In mediastinitis involving instrumental and foreign bodies esophageal perforation, we can not recommend any particular surgical tactic.