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Classification for Postoperative Mediastinitis

Purpose: To classify a patient with mediastinitis following cardiopulmonary bypass using the scheme of El Oakley and Wright.

Description

El Oakley and Wright developed a classification for mediastinitis that occurred in patients following cardiopulmonary bypass surgery. This is a serious infection that can be hard to treat and which can be life threatening. The authors are from the Royal Brompton and London Chest Hospitals.


 

Presentation After Surgery

Number of Risk Factors

Treatment

Type

< 2 weeks

0

untreated or treated successfully

I

2 – 6 weeks

0

untreated or treated successfully

II

< 2 weeks

>= 1

untreated or treated successfully

IIIA

2 – 6 weeks

>= 1

untreated or treated successfully

IIIB

<= 6 weeks

>= 0

1 failed therapeutic trial

IVA

<= 6 weeks

>= 0

> 1 failed therapeutic trial

IVB

> 6 weeks

>= 0

untreated or treated

V

 

Risk factors for mediastinitis include:

(1) diabetes mellitus

(2) obesity (body weight > 120% of normal weight for height and gender)

(3) immunosuppressive therapy

 

where:

• These risk factors are listed in the footnote to the Table.

• Other risk factors mentioned in the text include (1) bilateral internal mammary artery grafts in the presence of diabetes, and (2) the need for multiple transfusions in the early postoperative period.


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Specialty

Objective

ICD-10