A bibliometric analysis of research trends in mediastinitis: a rare, high mortality, and complex infectious disease

Abstract

Background

Mediastinitis is a severe infectious disease with complex etiology and high mortality. Existing research involves multiple disciplines, including thoracic surgery, infectious diseases, and radiology, and the findings are relatively scattered. This study aims to analyze the current state and research hotspots of mediastinitis using bibliometric methods, providing a comprehensive analysis of the development in this field and offering guidance and references for future research in this area.

Methods

Publications related to mediastinitis from 2005 to 2024 were retrieved from the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace, and the R package “bibliometrix” were used for visual analysis of countries, authors, and keywords in selected literature.

Results

A total of 1,510 articles from 64 countries were included in this study. The publication volume in the field of mediastinitis has stabilized in recent years. Major research hubs include the United States, China, Japan, and Europe. Interactive Cardiovascular and Thoracic Surgery is the most productive journal, while Annals of Thoracic Surgery is the most cited in collaborative research. Research contributions come from 7,478 authors, with Ingemansson R being the most prolific contributor. The most common keyword is “management”. Keyword clustering analysis revealed three main research areas: etiology, treatment, and complications. The keyword emergence results indicate that early studies have focused on complications following thoracic surgery. Recent research has shifted its attention to non-surgical sources of infections, chronic types, and their associated complications.

Conclusions

Mediastinitis is a rare and critical condition with complexity, and a single diagnosis and treatment approach is often insufficient to address it. A multidisciplinary collaborative management system is of vital importance for improving the prognosis of such patients. Research on mediastinitis shows a clear regional imbalance, and cross-team and international collaboration should be strengthened to promote the development of a systematic body of research in this field. Non-surgical mediastinitis and chronic mediastinitis, especially when combined with chronic diseases such as diabetes, may become the focus of future research.

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Key findings

• This study presents the first systematic bibliometric analysis of the mediastinitis field. The results show significant regional imbalances in global research output and limited international collaboration. In addition, non-surgery-related mediastinitis and chronic mediastinitis, especially cases complicated by chronic diseases such as diabetes, are gradually emerging as research hotspots.

What is known and what is new?

• Mediastinitis is a small but critical discipline. The most common type is postoperative mediastinitis. Beyond surgical intervention, multidisciplinary collaborative diagnosis and treatment have been recognized as essential for improving prognosis.

• This study reveals that research efforts in mediastinitis are concentrated in a few countries or institutions, with insufficient international cooperation. It also identifies non-surgery-related and chronic mediastinitis (particularly with comorbid diabetes) as future research hotspots.

What is the implication, and what should change now?

• Clinically, multidisciplinary collaborative management should be strengthened, and standardized diagnostic and treatment pathways should be established. In research, cross-center and cross-national collaboration and data sharing should be enhanced, along with the creation of multicenter cohorts or registries. Future studies should prioritize mechanistic research and clinical trials on non-surgery-related and chronic mediastinitis, especially long-term follow-up and individualized treatment strategies for patients with comorbid diabetes.

Introduction

Mediastinitis, as a clinically rare and fatal infectious disease, exhibits varying incidence rates depending on the underlying causes. The overall incidence of postoperative mediastinitis is approximately 0.25% to 5%, while the incidence associated with esophageal perforation can be as high as 17% (1,2). The overall mortality rate is around 40% (3).

According to etiological origin and pathological progression, mediastinitis can be broadly classified into acute mediastinitis and chronic fibrosing mediastinitis (4). Acute mediastinitis is the most common clinical subtype and mainly includes mediastinitis after cardiac and great-vessel surgery, mediastinitis secondary to esophageal perforation or infection, extension of airway and pulmonary infections, and descending necrotizing mediastinitis (DNM) resulting from the downward spread of head and neck infections. Chronic fibrosing mediastinitis is characterized by abnormal proliferation of fibrous tissue within the mediastinum and is associated with granulomatous infections such as tuberculosis and histoplasmosis (5,6). Although different types of mediastinitis differ substantially in etiology, pathology, and therapeutic strategies, existing studies are mostly limited to single-center case reports and retrospective case series. Comprehensive insights into the evolution of knowledge and collaborative networks in this field remain lacking, and systematic overviews of the literature are scarce.

Bibliometrics, through the quantitative analysis of the distribution, relationships, and dynamic evolution of academic literature, provides a methodological framework for revealing the development patterns of a discipline. Since Pritchard [1969] first defined it (7), this technique has been widely applied to identify research hotspots, track paradigm shifts, and optimize resource allocation. Compared to traditional reviews, its advantages (8) are as follows: (I) data-driven decision-making: it reveals hidden knowledge associations (such as country/institution collaboration patterns and theme clustering features) based on large-scale literature datasets; (II) temporal dynamic analysis: it captures key turning points in the evolution of the field through burst detection and timeline mapping; (III) visualization: by using the VOS clustering algorithm and force-directed layout, it transforms complex knowledge structures into interactive scientific maps (9).

This study conducts a bibliometric analysis of mediastinitis-related literature from 2005 to 2024 based on the Web of Science Core Collection (WoSCC) database. By integrating tools such as VOSviewer, CiteSpace, and the R package “bibliometrix”, it presents the first cross-decadal analysis of mediastinitis literature. The aim is to provide references for the research directions of mediastinitis. We present this article in accordance with the BIBLIO reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1333/rc).

Methods

Data source

The data for this study was sourced from the WoSCC, with the indexes set to Science Citation Index Expanded (SCI-EXPANDED) and Social Sciences Citation Index (SSCI). The search query used was TS = ((“mediastinitis”) OR (“mediastinal infection”) OR (“acute mediastinitis”) OR (“descending necrotizing mediastinitis”) OR (“poststernotomy mediastinitis”) OR (“chronic fibrosing mediastinitis”)), covering the time span from January 1, 2005, to December 31, 2024. A total of 2,447 publications were retrieved. Inclusion criteria: the article types were “Article” and “Review”. Exclusion criteria: (I) articles unrelated to the research topic of this study; (II) duplicate publications. A total of 1,510 valid publications were included (Figure 1).

Figure 1.

Literature screening flowchart. Screening based on PRISMA criteria (10).

Research instruments

This study used CiteSpace (6.2.7.0), VOSviewer (1.6.20.0), and the R package “bibliometrix” (2024.12.1.0) to construct knowledge maps of the countries, authors, journals, and keywords in the field from the valid literature.

Data analysis

VOSviewer, as a network visualization tool, is capable of systematically extracting and analyzing key feature information from academic publications (11). It combines mapping and clustering algorithms to construct the network structure of the literature, revealing the inherent structural features of a knowledge domain through multidimensional maps (12). Specifically, nodes represent analytical units such as countries, institutions, journals, or authors. The size of a node is positively correlated with the number of the respective analytical units. Different colors indicate different clusters, while the connections between nodes represent collaborative relationships. The thickness of the lines reflects the extent of cooperation or co-citation among the analytical units (13). In our study, VOSviewer was used to visualize the collaborative network maps among countries, journals, authors, and their affiliated institutions. CiteSpace, developed by Professor Chen Chaomei’s team, is capable of designing cluster and timeline views to visualize emerging trends and fleeting patterns in scientific literature (14,15). In this study, the software was used to create keyword clustering, keyword timeline maps, and keyword burst detection maps. To further improve the analytical validity, this study introduced the “bibliometrix” package in the R programming environment for supplementary analysis (16). In this study, the package was used to display the distribution characteristics of authors and their affiliated institutions, the national distribution of mediastinitis research, the evolution of publication trends by authors and journals, among others. Its network analysis module effectively complemented the map interpretation provided by VOSviewer. Excel 2019 was used to create line charts of publication volume and other descriptive analysis tables.

Results

Publication volume and trend analysis

The volume of publications is an important indicator for assessing the theoretical level and developmental trends in the field of mediastinitis research. The publication volume on mediastinitis showed an upward trend in the early years [2005–2013], reaching its peak in 2013 with 104 articles. From 2013 to 2015, a decline was observed. However, in the past decade [2015–2024], the number of publications has stabilized, fluctuating between 59 and 84 articles (Figure 2).

Figure 2.

Annual number of publications on mediastinitis research.

Analysis of countries/regions of publication

Publications in the field of mediastinitis research originated from 64 countries/regions. Table 1 presents the publication outputs of the top 10 countries/regions ranked by the number of publications. The results showed that the United States, China, Japan, Germany, and Italy together contributed more than half of the total publications (51.2%), indicating that research activity in this field is highly concentrated in a limited number of countries.

Table 1. The top ten countries/regions in terms of document issuance volume.

Rank	Publication output					Total citations		Average citations
	Country/regon	Count (%)	SCP	MCP (%)	H-index	Country/regon	Values	Country/regon	Values
1	USA	286 (18.9)	262	24 (8.4)	40	USA	6,438	Sweden	31.8
2	China	145 (9.6)	137	8 (5.5)	19	Germany	1,830	Singapore	29
3	Japan	134 (8.9)	132	2 (1.5)	18	Sweden	1,368	Norway	25
4	Germany	128 (8.5)	119	9 (7.0)	28	Japan	1,267	Finland	24.4
5	Italy	80 (5.3)	70	10 (12.5)	20	France	1,192	Slovenia	23
6	France	79 (5.2)	68	11 (13.9)	34	Italy	1,169	USA	22.5
7	Turkey	76 (5.0)	75	1 (1.3)	11	China	1,111	United Kingdom	21.6
8	Spain	54 (3.6)	48	6 (11.1)	14	United Kingdom	1,100	Iceland	21.1
9	United Kingdom	51 (3.4)	44	7 (13.7)	34	Spain	676	Ireland	20.8
10	Sweden	43 (2.8)	39	4 (9.3)	24	Netherlands	512	Netherlands	19

Data are presented as n or n (%). MCP, multiple country publications; SCP, single country publications.

Among these countries, the United States ranked first in the number of publications (286, 18.9%), total citations [6,438], and H-index [40], far exceeding all other countries, which indicates its substantial influence in this field. Although China ranked second in publication output (145, 9.6%), it ranked only seventh in total citations [1,111], with a moderate H-index of 19, reflecting a pattern of high productivity but moderate academic impact. Sweden ranked tenth in publication output [43]; however, it had the highest average number of citations per publication [31.8], suggesting that it achieved a relatively high per-article impact despite its smaller publication volume (Figure 3A).

Figure 3.

Publication output and collaboration patterns by countries/regions. (A) The top ten countries/regions ranked by total citation count. (B) The top ten countries/regions ranked by the number of publications, with red representing MCP and green representing SCP. The length of each bar corresponds to the publication quantity. (C) The collaboration network map among publishing countries/regions, where nodes represent countries, with different colors indicating different clusters. The size of the nodes is proportional to the number of publications, and the lines between the nodes represent collaborative relationships, with the thickness of the lines indicating the strength of collaboration. (D) A world map of publishing countries, where lines represent collaborations, with thicker lines indicating closer cooperation. MCP, multiple country publications; SCP, single country publications.

In terms of international collaboration, although the United States, China, and Japan had relatively high total publication outputs, their international collaboration rates [multiple country publications (MCP)%] were comparatively low, at 8.0%, 5.5%, and 1.5%, respectively. This indicates that research in these countries was predominantly driven by domestic collaboration, with limited participation in international collaborative activities. In contrast, European countries generally exhibited higher levels of international collaboration, with MCP% values of 12.5% for Italy, 13.9% for France, and 13.7% for the United Kingdom, reflecting close collaborative relationships among European countries (Figure 3B). The national collaboration network (Figure 3C,3D) further reveals the global collaboration landscape. The United States, Germany, Italy, and France occupy central positions within the global collaboration network, characterized by larger node sizes and dense international collaboration links, forming the core of international cooperation in this field.

Analysis of authors and their affiliated institutions

Analyzing the contributing authors and their affiliated institutions provides insight into the leading scholars and core research forces in the field. A total of 1,331 institutions have participated in research on mediastinitis, with 121 institutions having published 10 or more papers (not shown in the article due to space limitations). The institution with the highest publication volume is Assistance Publique Hopitaux Paris (APHP) in France. The top ten institutions are located in the United States, China, and European countries. These articles involve 7,478 authors, with the three authors having the highest publication volumes being Ingemansson R, Malmsjö M, and Lindstedt S. Among the top ten authors by publication volume, Chen SL and Chin SC have made recent contributions to the field (Figure 4A). Seventy-five percent of mediastinitis researchers have published only one article, and the proportion of authors with more than ten publications is extremely low. This follows the power-law distribution described by Lotka’s law (17), indicating that a small number of highly productive authors contribute the majority of the research output in this field (Figure 4B). Authors researching mediastinitis and their affiliated institutions have formed collaborative teams; however, there is no collaboration, or only weak collaboration, between these teams (Figure 4C,4D). Additionally, most of these authors are affiliated with universities and hospitals, with very few coming from large research institutions (Table 2).

Figure 4.

Author and institutional contributions to publications. (A) The annual publication volume (dark blue) and annual citation count (light blue) of the top ten authors ranked by publication quantity. The size of the circles is proportional to both the annual publication volume and citation count. (B) Lotka’s law. (C,D) Collaboration network maps between publishing authors and their affiliated institutions. Nodes represent authors or institutions, with different colors indicating different clusters. The size of the nodes is proportional to the publication volume, and the lines between the nodes represent collaboration relationships, with thicker lines indicating stronger cooperation. N, number; TC, total citations.

Table 2. Top 10 organizations and authors in the number of publications.

Rank	Institution	Country	Counts	Authors
1	APHP	France	84	Ingemansson R
2	Lund University	Sweden	81	Malmsjö M
3	Harvard University	USA	65	Lindstedt S
4	Mayo Clinic	USA	65	Sjögren J
5	Skane University Hospital	Sweden	63	Chen SL
6	Université Paris Cité	France	63	Gudbjartsson T
7	University Of Pennsylvania	USA	54	Gustafsson R
8	Chang Gung Memorial Hospital	China	41	Petzina R
9	Harvard University Medical Affiliates	USA	41	Zhang WJ
10	INSERM	France	36	Chin SC

APHP, Assistance Publique Hopitaux Paris; INSERM, Institut National De La Santé Et De La Recherche Médicale.

Journal analysis of publications

Analyzing the journals that publish research on mediastinitis can provide insights into the primary platforms for academic achievements in this field, helping to better understand the overall impact and core dissemination channels within the discipline. Research on mediastinitis has been published in 489 different journals, with 29 journals publishing 10 or more articles (not displayed due to space limitations). Table 3 presents the top 10 journals in terms of publication volume in the field of mediastinitis research, with a total of 316 articles, accounting for 20.9% of the overall publications. These journals are primarily located in European countries and the United States. Interactive Cardiovascular and Thoracic Surgery (47 articles) is the journal with the highest number of publications, while Annals of Thoracic Surgery (4,119 citations) has the highest total citation count (Figure 5A). The annual publication trends of the top five journals show an upward trajectory, indicating a steady increase in the number of articles published by these journals each year. This demonstrates their ongoing contribution to research on mediastinitis (Figure 5B).

Table 3. Top 10 journals in the number of publications.

Rank	Sources	Articles	Country
1	Interactive Cardiovascular and Thoracic Surgery	47	United Kingdom
2	Annals of Thoracic Surgery	44	USA
3	Journal of Cardiothoracic Surgery	35	United Kingdom
4	European Journal of Cardio-Thoracic Surgery	34	United Kingdom
5	The Thoracic and Cardiovascular Surgeon	31	Germany
6	Journal of Cardiac Surgery	29	USA
7	Annals of Thoracic and Cardiovascular Surgery	27	Japan
8	International Wound Journal	27	United Kingdom
9	European Archives of Oto-Rhino-Laryngology	22	Germany
10	Revista Brasileira De Cirurgia Cardiovascular	20	Brazil

Data are presented as n.

Figure 5.

Contribution of publishing journals. (A) The top ten journals ranked by total citation count. (B) The cumulative publication volume by year for the top five journals ranked by publication quantity.

Keyword analysis

A total of 546 keywords were identified, with an overall occurrence frequency of 5,399. Among them, 91 keywords appeared 10 times or more (not displayed in the text). Table 4 presents the basic information of the top 10 keywords based on frequency and centrality. Keywords that appeared more than 200 times include “management”, “cardiac surgery”, “risk factors” and “mediastinitis”. Keywords such as “descending necrotizing mediastinitis”, “esophageal perforation”, “diagnosis”, “surgery”, and “mortality” all have a centrality score of ≥0.10, indicating that these high-centrality keywords play a crucial role in the field of mediastinitis research (18).

Table 4. Top 10 keywords in occurrence frequency and centrality.

Rank	Counts		Centrality
	Keyword	Values	Keyword	Values
1	Management	389	Descending necrotizing mediastinitis	0.12
2	Cardiac surgery	265	Esophageal perforation	0.11
3	Risk factors	229	Diagnosis	0.11
4	Mediastinitis	206	Surgery	0.1
5	Poststernotomy mediastinitis	141	Mortality	0.1
6	Vacuum assisted closure	141	Infections	0.09
7	Complications	134	Children	0.09
8	Descending necrotizing mediastinitis	132	Prevention	0.08
9	Surgery	110	Experience	0.08
10	Infection	100	Poststernotomy mediastinitis	0.07

Keyword clustering and timeline analysis

This study identified a total of 10 clusters. The modularity value (Q) of the clustering map is 0.3851 (>0.3000), and the mean silhouette value (S) is 0.7432 (>0.7000), indicating that the clustering structure is significant and the results are reliable (19). A summary of the 10 cluster labels reveals that research on mediastinitis mainly focuses on three key themes (Figure 6A). (I) Etiology: #0 deep neck infection, #1 cardiac surgery, #2 sternal osteomyelitis, #3 deep sternal wound infection, #4 esophageal perforation, #7 fumigatus; (II) treatment: #8 polymerase chain reaction (PCR), #9 a pump-type tube; (III) complications: #2 sternal osteomyelitis, #6 pseudoaneurysm, #5 pulmonary hypertension. Analyzing the timeline of mediastinitis research allows for a comparison of the changes in research intensity for different keyword clusters over specific time periods. Clusters #0 deep neck infection, #1 cardiac surgery, #2 sternal osteomyelitis, #3 deep sternal wound infection, and #4 esophageal perforation, which represent the etiology theme, became key focuses in mediastinitis research from the early stages. The keyword cluster “polymerase chain reaction (PCR)” became a hot topic in research from 2009 to 2019, but after 2017, related studies have become more dispersed or less concentrated. The keyword cluster “a pump-type tube” has been a consistent focus of research from 2020 to the present (Figure 6B).

Figure 6.

Keyword clustering and timeline visualization. (A) Keyword clustering, with different colors representing different clusters. The overlap between clusters indicates shared themes or keywords. (B) A timeline of keyword clusters. Nodes represent keywords, with the size of the nodes proportional to the frequency of the keywords. The color of the nodes indicates the time of occurrence, with darker purple representing earlier occurrences and brighter red indicating more recent ones. The lines between nodes represent co-occurrence or citation relationships between keywords, with the color of the labels and lines indicating different clusters.

Analysis of keyword burst

Building upon the keyword clustering, a further burst analysis of the keywords is conducted. Figure 7 displays the top 20 burst keywords with the highest citation intensity in the field of mediastinitis research over the past two decades. The keyword with the strongest burst intensity is “deep neck infection”, followed by “fibrosing mediastinitis”. The keyword with the longest burst duration is “deep sternal wound infection” with a span of 10 years. The keywords that experienced early bursts include “sternal wound complications”, “thoracic surgery”, “drainage” and “operations”. Keywords such as “deep neck infection”, “fibrosing mediastinitis”, “pulmonary vein stenosis”, “case report”, “space infections”, “pulmonary hypertension”, “congenital heart disease” and “deep sternal wound infection” have experienced continuous bursts over the past 3 years. Among these, “pulmonary hypertension”, “pulmonary vein stenosis” and “case report” have shown burst patterns since their emergence. On the other hand, “congenital heart disease”, “deep neck infection”, “space infections” and “fibrosing mediastinitis” emerged earlier but only began to experience bursts in recent years. On complex types (fibrosing mediastinitis) and their complications. This indicates and directions have shifted toward complex conditions (such as fibrosing mediastinitis) and their complications. The focus of etiological investigations has also shifted from postoperative complications to non-surgical causes, with increasing emphasis on individualized treatment strategies. Case reports represent the predominant publication type (Figure 7).

Figure 7.

Top 20 keywords with the strongest citation bursts. “Strength” represents the intensity of the bursts, while “Begin” and “End” refer to the start and end times of the bursts, corresponding to the length of the red portion in the figure.

Discussion

The number of publications on early-stage mediastinitis first increased and then decreased, but over the past decade, the publication volume has tended to stabilize. This indicates that although mediastinitis is a rare disease, the attention it has received over the past 10 years has not shown significant fluctuations despite advances in science and technology. The reason may be that research on mediastinitis falls within the niche category of critical illnesses and has not yet become a large-scale research hotspot. Although the incidence of mediastinitis is low, its mortality rate is high. As a multidisciplinary and cross-disciplinary disease—affecting areas such as cardiothoracic surgery, infectious diseases, and critical care—it is complex and attracts attention from multiple fields (4,20,21).

The countries, institutions, authors and their teams, and journals publishing research on mediastinitis are mostly located in the United States, China, Japan, and Europe, showing a clear regional imbalance. Findings are mainly concentrated in countries with well-developed cardiac and thoracic surgery fields, while participation from developing countries remains limited. This may be attributed to the fact that the most common cause of mediastinitis is postoperative complications following cardiothoracic surgery (22). China has produced substantial outputs in this field; however, its international impact has not increased proportionally with its publication volume, which may be associated with limited international collaboration. The authors of collaboration within teams, but the collaboration network between teams is sparse, lacking large-scale international and multicenter collaboration. The possible reason for the above situation may be that different teams have different research directions and priorities, indicating that specialized research on mediastinitis has not yet formed a systematic framework. This may ultimately contribute to the relatively low overall number of publications in this field. In the future, cross-team and international collaboration should be strengthened.

Keyword frequency and centrality suggest that factors such as risk factor identification, early diagnosis, infection, and high mortality rate are driving the development of the mediastinitis field. Studies have shown that early diagnosis of mediastinitis is crucial for improving the cure rate, and early CT evaluation helps rapidly identify mediastinitis (23,24). The use of appropriate antibiotics can also significantly reduce mortality (25,26), while genetic testing technology provides precise guidance for antibiotic selection (27). Timely mediastinal debridement and drainage, along with meticulous postoperative care, can effectively reduce postoperative complications, improve patients’ quality of life, and lower mortality (28). Therefore, improving the identification of early risk factors, timely early computed tomography/magnetic resonance imaging (CT/MRI) assessment, standardized anti-infection treatment and surgical debridement and drainage, along with optimizing nursing and therapeutic measures, is expected to enhance the overall treatment level of mediastinitis.

A study has shown that the mortality rate of mediastinitis varies at different stages, exhibiting a gradually decreasing trend, which can be attributed to the standardized management of mediastinitis (29). Therefore, the selection and optimization of medical and surgical nursing models in this field are particularly important. Moreover, mediastinitis involves multiple causes and anatomical structures, and the condition is often quite complex. The knowledge and methods of a single discipline are insufficient for comprehensive and accurate diagnosis, evaluation, and treatment. Therefore, multidisciplinary management holds great potential in the field of mediastinitis. Specifically, thoracic surgery plays a key role in eliminating the infectious focus, selecting the appropriate mediastinal drainage approach, and formulating the surgical strategy. The infectious disease department can assist with pathogen analysis and optimization of antimicrobial therapy. The intensive care unit also plays an important role in sepsis management, organ support, and perioperative monitoring. In addition, for DNM caused by the downward spread of head and neck infections, involvement of otolaryngology or related specialties in managing the primary infectious focus is equally important for controlling disease progression (30,31).

Although early diagnosis and multidisciplinary collaboration are key to improving patient survival and treatment outcomes, substantial regional disparities in medical technology remain. Therefore, treatment models for mediastinitis still require further exploration to better meet the clinical needs of different regions. At present, the number of standardized clinical practice guidelines in the field of mediastinitis is limited, and their updates have been relatively slow. The 2017 European Association for Cardio-Thoracic Surgery Expert Consensus Statement on the Prevention and Management of Mediastinitis was the first comprehensive international consensus in this field and has provided an important reference for clinical practice (4); however, it has not been updated to date. To promote the standardization of diagnosis and treatment in this field, there is an urgent need to develop or update guidelines based on higher-level evidence from evidence-based medicine in the future.

Etiological clustering shows that secondary mediastinitis has always been a research hotspot in this field. With the gradual shift from conventional open thoracic surgery to minimally invasive surgery, and with increased awareness of perioperative management (32), the incidence and mortality of surgery-related mediastinitis have declined. However, the incidence of non-surgery-related mediastinitis and chronic fibrosing mediastinitis has gradually increased, and no significant decline in mortality has been observed (33). On the one hand, this is because non-surgery-related mediastinitis often has an insidious onset and progresses rapidly. On the other hand, chronic fibrosing mediastinitis mainly manifests as compression of mediastinal structures, follows a chronic progressive course, and lacks specific effective treatment options. In addition, it is also associated with limited medical resources, prolonged waiting times for medical care, and chronic underlying diseases such as diabetes (34). Our previous study also found that diabetes may be one of the independent risk factors for mortality in DNM (35). Therefore, this type of mediastinitis, especially in patients with chronic conditions such as diabetes, should be one of the key focuses of future research.

Limitations

This study is based on data from WoSCC, which only includes publications classified as reviews and articles, thus limiting the comprehensiveness of the research. The data is in English, which introduces potential bias and may underestimate the contributions of non-English-speaking countries (such as Chinese and Japanese journals not being included) in the field of mediastinitis research. Future efforts should be devoted to developing methods and indicators that incorporate scientific outputs not covered by Web of Science or Scopus. Additionally, the research time is up to December 31, 2024, with an indexing lag.

Conclusions

Mediastinitis is a rare and critical condition with complexity, and a single diagnosis and treatment approach is often insufficient to address it. A multidisciplinary collaborative management system is of vital importance for improving the prognosis of such patients. Research on mediastinitis shows a clear regional imbalance, and cross-team and international collaboration should be strengthened to promote the development of a systematic body of research in this field. Non-surgical mediastinitis and chronic mediastinitis, especially when combined with chronic diseases such as diabetes, may become the focus of future research.

Supplementary

The article’s supplementary files as

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.