Abstract: Objective To discuss the clinical factors related to an increased risk for the requirement of surgical drainage and a prolonged length of hospital stay in cases of a deep-space neck abscess with a mediastinal abscess and to better determine the surgical treatment options. Methods The clinical data of 61 consecutive patients with mediastinal abscesses between January 2008 and August 2017 were reviewed retrospectively. The Wilcoxon rank-sum test was adopted for the analysis. Logistic regression analysis was used to study the clinical risk factors by stepwise forward regression. Results The mortality rate of the mediastinal abscess reached 16.4%. At an ɑ level of 0.05, the factors that delayed hospitalization duration included diabetes, maximum abscess dimension ≥3 cm, and surgery(W test: P=0.002, P=0.047, and P=0.042). Age sex, white blood cell count, fever, dyspnea, and timely surgery did not prolong hospitalization duration. Dyspnea increased the risk for requirement of surgical drainage(β=3.001; odds ratio ［OR］=20.099). Diabetes and maximum abscess dimension ≥3 cm increased the likelihood of not only surgical treatment(β=1.942, OR=2.565; β=2.369,OR=10.979)but also medical therapy failure(β=2.889,OR=18.147; β=4.048, OR= 57.303). Conclusion Active preoperative preparation and surgical intervention should be performed as soon as possible in patients with diabetes, dyspnea, and maximum abscess dimension ≥3 cm. However, patients without diabetes, dyspnea, and maximum abscess dimension ≥3 cm may recover without surgical incision and drainage under sufficient and effective intravenous antibiotic treatment alone with close surveillance. The result of treatment was satisfactory with surgical incision and drainage. A double-chamber tube should be a good choice. Abstraction of pus was effective and reduced surgical injury.

Key words: Subphrenic, abscess, Surgical procedures, operative, Drainage, Regression analysis