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Surgical site infections (SSI) are more common with delayed sternal closure (DSC) after congenital heart surgery (CHS). Open chest duration (OCD) of four or more days significantly increases SSI risk.

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Area of Science:

  • Cardiovascular Surgery
  • Infectious Disease Epidemiology

Background:

  • Surgical site infections (SSI) are a significant complication following congenital heart surgery (CHS).
  • Delayed sternal closure (DSC) is a common strategy to manage hemodynamic instability but may impact infection rates.
  • Understanding the relationship between DSC, open chest duration (OCD), and SSI is crucial for patient outcomes.

Purpose of the Study:

  • To compare the incidence of SSI in patients undergoing DSC versus primary chest closure (PCC) after CHS.
  • To identify a critical open chest duration (OCD) threshold associated with an increased risk of SSI.
  • To evaluate OCD as a modifiable risk factor for SSI in CHS patients.

Main Methods:

  • Retrospective review of a congenital heart surgery (CHS) dataset from 2015-2020.
  • Comparison of SSI incidence between DSC and PCC patient groups.
  • Analysis of the association between open chest duration (OCD) and SSI incidence within the DSC cohort.

Main Results:

  • The overall SSI incidence was 1.8% (47/2,582).
  • DSC patients (8.7% SSI) had a significantly higher SSI rate than PCC patients (1.3% SSI, p < 0.001).
  • An open chest duration (OCD) of four or more days was associated with a significantly higher SSI incidence (17.7%) compared to shorter durations (5.3%, p = 0.006).

Conclusions:

  • Delayed sternal closure (DSC) is associated with a higher incidence of surgical site infections (SSI) following congenital heart surgery (CHS).
  • Prolonged open chest duration (OCD) of four days or more is a significant risk factor for SSI.
  • Daily assessment for chest closure candidacy may help minimize SSI risk in CHS patients.