{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:22:52Z","timestamp":1791915772581,"version":"4.3.4"},"reference-count":19,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u2265 60 years (p:0.031), cervicotomy alone as surgical approach (p = 0.040), and the bilateral approach (p = 0.048) resulted in significance in terms of the univariate analysis; age \u2265 60 years (p = 0.04) and cervical approach (p = 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.<\/jats:p>","DOI":"10.3390\/jcm11216364","type":"journal-article","created":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T07:26:50Z","timestamp":1667114810000},"page":"6364","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5563-0331","authenticated-orcid":false,"given":"Maria Teresa","family":"Congedo","sequence":"first","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Nachira","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano Alberto","family":"Pennisi","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-6911","authenticated-orcid":false,"given":"Marco","family":"Chiappetta","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Bello","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Parrilla","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Unit of Otorhinolaryngology, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8638-7565","authenticated-orcid":false,"given":"Laura","family":"Franza","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6709-2531","authenticated-orcid":false,"given":"Marcello","family":"Covino","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Petracca Ciavarella","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venanzio","family":"Porziella","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Letizia","family":"Vita","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-5554","authenticated-orcid":false,"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Margaritora","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Meacci","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.2174\/1874300501105010012","article-title":"Descending Necrotizing Mediastinitis: Review of the Literature and Controversies in Management","volume":"5","author":"Foroulis","year":"2011","journal-title":"Open. Surg. J."},{"key":"ref_2","first-page":"182","article-title":"Mortality risk factors in descending necrotizing mediastinitis","volume":"46","author":"Montserrat","year":"2010","journal-title":"Arch. Bronconeumol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1016\/j.joms.2011.05.007","article-title":"Cervical necrotizing fasciitis with descending mediastinitis: Literature review and case report","volume":"70","author":"Sarna","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1001\/archotol.1971.00770060932017","article-title":"Fatal mediastinitis following retropharyngeal abscess","volume":"93","author":"Janecka","year":"1971","journal-title":"Arch. Otolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1001\/jama.1976.03270100048029","article-title":"Nontraumatic mediastinitis","volume":"236","author":"Enquist","year":"1976","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1136\/thx.52.8.702","article-title":"Optimal treatment of descending necrotising mediastinitis","volume":"52","author":"Corsten","year":"1997","journal-title":"Thorax"},{"key":"ref_7","first-page":"545","article-title":"Descending necrotizing mediastinitis","volume":"157","author":"Estrera","year":"1983","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/BF03217934","article-title":"Guideline of surgical management based on diffusion of descending necrotizing mediastinitis","volume":"47","author":"Endo","year":"1999","journal-title":"Jpn. J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"356","DOI":"10.21037\/atm-21-121","article-title":"A new classification of descending necrotizing mediastinitis and surgical strategies","volume":"9","author":"Guan","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1097\/SLA.0b013e3181c1b0d1","article-title":"Descending necrotizing mediastinitis: Contemporary trends in etiology, diagnosis, management, and outcome","volume":"251","author":"Ridder","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/0218492319896515","article-title":"Deep cervical and paratracheal drainage for descending necrotizing mediastinitis","volume":"28","author":"Sakai","year":"2020","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/bjs.6935","article-title":"Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis","volume":"97","author":"Karkas","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"De Palma, A., Cantatore, M.G., Di Gennaro, F., Signore, F., Panza, T., Brascia, D., De Iaco, G., Sampietro, D., Quercia, R., and Genualdo, M. (2022). Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience. Antibiotics, 16.","DOI":"10.3390\/antibiotics11050664"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"840070","DOI":"10.3389\/fsurg.2022.840070","article-title":"Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer","volume":"4","author":"Nachira","year":"2022","journal-title":"Front. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/S0003-4975(03)01333-X","article-title":"Descending necrotizing mediastinitis: A minimally invasive approach using video-assisted thoracoscopic surgery","volume":"77","author":"Min","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/BF00311590","article-title":"Successful utilization of the median sternotomy approach in the management of descending necrotizing mediastinitis: Report of case","volume":"26","author":"Izumoto","year":"1996","journal-title":"Surg. Today"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/S0003-4975(96)00683-2","article-title":"Descending necrotizing mediastinitis: Surgical treatment via clamshell approach","volume":"62","author":"Ris","year":"1996","journal-title":"Ann. Thorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1093\/ejcts\/ezs385","article-title":"Diffuse descending necrotizing mediastinitis: Surgical therapy and outcome in a single-centre series","volume":"42","author":"Kocher","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.joms.2021.08.159","article-title":"Optimal Airway Management in the Treatment of Descending Necrotizing Mediastinitis Secondary to Deep Neck Infection","volume":"80","author":"Kim","year":"2022","journal-title":"J. Oral Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6364\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:04:37Z","timestamp":1760144677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,28]]},"references-count":19,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11216364"],"URL":"https:\/\/doi.org\/10.3390\/jcm11216364","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,28]]}}}