Minimization of Surgical Site Infections in Patients With Delayed Sternal Closure After Pediatric Cardiac Surgery
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Mouhammad Yabrodi1, Jeremy L Hermann2, John W Brown2
11 Division of Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Delayed sternal closure (DSC) in pediatric cardiac surgery can lead to infections. This study found that closing the skin over the open sternum reduced infectious complications to 9.1%, a lower rate than previously reported.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Infectious Disease
Background:
- Delayed sternal closure (DSC) is common after pediatric cardiac surgery.
- Infectious complications affect 18.7% of patients undergoing DSC.
- This study investigates institutional practices to minimize infection risk during DSC.
Purpose of the Study:
- To describe institutional experience with DSC.
- To test the hypothesis that specific DSC practices reduce infectious complications.
- To compare infectious complication rates with existing literature.
Main Methods:
- Retrospective review of 165 pediatric patients (<365 days) undergoing DSC (2012-2016).
- Infectious complications defined by Society of Thoracic Surgeons Congenital Heart Surgery Database criteria.
- Comparison of patient characteristics with and without infectious complications using statistical tests.
Main Results:
- 165 patients underwent DSC; 82% had skin closure over the open sternum.
- Median duration of open sternum was 3 days.
- Infectious complications occurred in 9.1% of patients (sepsis, pneumonia, wound infection), with no mediastinitis.
Conclusions:
- Institutional DSC practices resulted in fewer infectious complications than previously reported.
- Closing skin over the open sternum may reduce surgical site infections.
- These practices could help other centers minimize DSC-related infectious complications.
Background:
Delayed sternal closure (DSC) following pediatric cardiac surgery is commonly implemented at many centers. Infectious complications occur in 18.7% of these patients based on recent multicenter data. We aimed to describe our experience with DSC, hypothesizing that our practices surrounding the implementation and maintenance of the open sternum during DSC minimize the risk of infectious complications.
Methods:
We reviewed patients less than 365 days who underwent DSC between 2012 and 2016 at our institution. Infectious complications as defined by the Society of Thoracic Surgeons Congenital Heart Surgery Database were recorded. Patients with and without infectious complications were compared using Wilcoxon rank sum tests or Fisher exact tests as appropriate.
Results:
We identified 165 patients less than 365 days old who underwent DSC, 135 (82%) of whom had their skin closed over their open sternum. Median duration of open sternum was 3 days (range: 1-32 days). Infectious complications occurred in 15 (9.1%) patients-13 developed clinical sepsis with positive blood cultures, one patient developed ventilator-associated pneumonia, and one patient developed wound infection (0.6%). No cases of mediastinitis occurred. No statistical differences in characteristics between patients with and without infectious complications could be identified.
Conclusion:
Infectious complications after DSC at our institution were notably less than reported in recent literature, primarily due to minimization of surgical site infections. Practices described in the article, including closing skin over the open sternum whenever possible, could potentially aid other institutions aiming to reduce infectious complications associated with DSC.
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