Efforts to Reduce Infections in Delayed Sternal Closure Patients: A Survey of Pediatric Practice
Cathy Woodward1, Richard Taylor1, Minnette Son2
1Pediatric Critical Care, Department of Pediatrics, UT Health San Antonio, TX, USA.
Insights
Pediatric cardiac surgery patients undergoing delayed sternal closure (DSC) face high sternal wound infection (SWI) risks. Preoperative baths and feeding protocols were associated with fewer SWIs in DSC patients.
Area of Science:
- Pediatric Cardiac Surgery
- Surgical Site Infections
- Wound Care
Background:
- Pediatric patients with open sternums after cardiac surgery have a higher risk of sternal wound infection (SWI).
- Current preventive strategies for SWI in patients undergoing delayed sternal closure (DSC) lack standardized guidelines.
- SWI in pediatric cardiac surgery is a significant financial burden on healthcare systems and families.
Purpose of the Study:
- To investigate the current practices of pediatric cardiac surgery programs in preventing infections in patients undergoing DSC.
- To determine if specific preventive measures are associated with reduced SWI rates in DSC patients.
Main Methods:
- A 33-question survey was distributed to chief surgeons at pediatric cardiac surgery programs across the United States.
- Data were collected from 28 responding programs, representing 6,484 pediatric cardiac surgery patients, including 807 who underwent DSC.
Main Results:
- Overall SWI rate was 2.4% for all patients and 6.3% for DSC patients.
- Pediatric patients undergoing DSC who received preoperative baths showed a significantly lower infection rate (5.9% vs. 15.8%, P = .015).
- Programs with established feeding protocols reported fewer SWIs in DSC patients (5.7% vs. 14.8%, P = .008).
Conclusions:
- Practices such as preoperative baths and feeding protocols may help reduce SWI in pediatric cardiac surgery patients undergoing DSC.
- Further multicenter research is needed to establish evidence-based guidelines for wound care and closure techniques to mitigate SWI.
Background:
Pediatric patients with sternum left open after cardiac surgery experience a higher risk for sternal wound infection (SWI). These infections are costly for programs, payers, and patients and their families. Despite efforts by individual programs to reduce infections in patients undergoing delayed sternal closure (DSC), there are no established guidelines that address preventive procedures. The purpose of this study was to determine the practice of pediatric cardiac surgery programs to prevent infection in their DSC patients and if preventive measures were associated with less infections.
Methods:
A 33 question survey on institutional practices was sent to chief surgeons at pediatric cardiac surgery programs in the United States.
Results:
Twenty-eight (35%) surgical programs responded. The mean number of pediatric cardiac bypass operations performed by programs in 2016 was 227 (range: 69-872). Data represented 6,484 patients <18 years of age who underwent cardiac surgery with 807 (12%) of those undergoing DSC. One hundred fifty-eight (2.4%) of all patients and 51 (6.3%) of the DSC patients developed a SWI. Patients with DSC who received preoperative baths were less likely to become infected (5.9% vs 15.8%; P = .015). Patients in programs with feeding protocols had fewer infections (5.7% vs 14.8%; P = .008).
Conclusions:
The results of this survey of children's cardiac surgery programs describe their practices to reduce infection rates in DSC patients. A multicenter project on wound care and closure techniques that might impact this costly complication is needed.
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