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Risk factors and risk adjustment for surgical site infections in pediatric cardiothoracic surgery patients
Annette H Sohn1, Jackie M Schwartz, Kathy Y Yang
1Division of Pediatric Infectious Diseases, University of California-San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA. sohna@peds.ucsf.edu
Insights
Children undergoing cardiac surgery face high risks for surgical site infections (SSIs). Perioperative medical interventions, especially in infants, increase SSI risk, while prolonged antibiotic use should be avoided without infection.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Congenital Heart Disease
Background:
- Children with congenital cardiac defects require complex medical management, increasing their risk of surgical site infections (SSIs).
- Surgical site infections (SSIs) pose a significant threat to pediatric patients recovering from cardiothoracic surgery.
Purpose of the Study:
- To identify risk factors for surgical site infections (SSIs) in children undergoing cardiothoracic surgery.
- To evaluate the impact of perioperative interventions on SSI development in this vulnerable population.
Main Methods:
- Retrospective review of pediatric cardiothoracic surgery cases from January 2000 to June 2001.
- Multivariate analysis of preoperative, intraoperative, and postoperative data to identify SSI predictors.
Main Results:
- A 6.3% SSI rate was observed (46 of 626 patients), with infections occurring superficially, in deep tissue, or organ space (including mediastinitis).
- Infants under 30 days old, perioperative medical device use, and parenteral nutrition were significantly associated with increased SSI risk.
- No association was found between SSI and severity of illness scores, RACHS-1 category, or prolonged postoperative antimicrobial duration.
Conclusions:
- Perioperative medical interventions are linked to a higher incidence of SSIs in young children post-cardiac surgery.
- Avoidance of prolonged postoperative antimicrobial therapy is recommended unless infection is confirmed.
Background:
The complexity of congenital cardiac defects and the aggressive medical management required to support patients through their recovery place children at high risk for surgical site infection (SSI).
Methods:
We conducted a retrospective review of children undergoing cardiothoracic surgery at a tertiary care referral center between January 1, 2000, and June 30, 2001. Preoperative, intraoperative, and postoperative data were assessed by multivariate analysis.
Results:
Of 726 surgical procedures performed in 626 patients, SSIs occurred after 46 procedures performed in 46 patients (6.3%). Infections were superficial (n = 22; 47.8%), deep tissue (n = 7; 15.2%), or organ space (n = 17; 37.0%), including 5 episodes of mediastinitis. Median time to SSI was 10 days; 36% of the infections were identified after discharge. On multivariate analysis, children with SSIs were more likely to have been <30 days old (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.2-70), to have a perioperative medical device, and to use parenteral nutrition (OR, 3.3; 95% CI, 1.4-7.9). Multiple severity of illness scores, the Risk Adjustment for Congenital Heart Surgery (RACHS-1) category, and longer duration of postoperative antimicrobials were not associated with SSI.
Conclusion:
The use of perioperative medical interventions increases the risk of SSI in young children after cardiac surgery. Prolonged postoperative courses of antimicrobials should be avoided in the absence of documented infection.
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