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Published on: May 26, 2023
Preoperative and Intraoperative Risk Factors for Surgical Site Infection in Pediatric Cardiac Surgery
Yoshihiro Takahashi1, Kentaro Ueno1, Koji Nakae1
1From the Department of Pediatrics, Kagoshima University Hospital, Kagoshima City, Kagoshima, Japan.
Insights
Low preoperative serum protein and albumin levels are risk factors for surgical site infections (SSI) in pediatric cardiac surgery. Assessing nutritional status preoperatively can help prevent SSI development in these young patients.
Area of Science:
- Pediatric Cardiac Surgery
- Infectious Disease Epidemiology
- Nutritional Science
Background:
- Surgical site infection (SSI) is a significant complication following pediatric cardiac surgery.
- Predicting SSI risk preoperatively allows for targeted preventive management.
- Understanding patient background factors is crucial for mitigating surgical risks.
Purpose of the Study:
- To identify preoperative risk factors for surgical site infection (SSI) in pediatric cardiac surgery.
- To evaluate the association between nutritional status and SSI development.
- To inform strategies for SSI prevention in young cardiac surgery patients.
Main Methods:
- Retrospective analysis of pediatric cardiac surgeries performed via median sternotomy (n=597) from 2011-2021.
- SSI diagnosis followed CDC guidelines, categorized into superficial incisional SSI (SiSSI), deep incisional SSI (DiSSI), and mediastinitis.
- Univariate analysis assessed preoperative factors, including serum protein and albumin levels.
Main Results:
- 17 (2.8%) of pediatric patients developed SSI, with mediastinitis being the most common type.
- Low preoperative serum protein (P=0.049) and low serum albumin (P=0.023) were identified as significant risk factors for SSI.
- Staphylococcus aureus was the predominant pathogen identified in SSI cases.
Conclusions:
- Low preoperative serum protein and albumin levels are significant risk factors for SSI in pediatric cardiac surgery.
- Malnutrition is suggested as the cause of low serum protein and albumin levels.
- Regular nutritional assessment and intervention are recommended for children undergoing cardiac surgery to prevent SSI.
Background:
Surgical site infection (SSI) is a major complication of pediatric cardiac surgery. If the risk of developing SSI can be predicted based on the patient's preoperative background, appropriate preoperative management to prevent the development of SSI can be achieved.
Methods:
We retrospectively studied cases for patients younger than 7 years of age among surgeries performed through a median sternotomy at Kagoshima University Hospital from April 2011 to March 2021. SSI was diagnosed according to the Centers for Disease Control and Prevention guidelines and classified into 3 types: superficial incisional SSI (SiSSI), deep incisional SSI (DiSSI) and mediastinitis.
Results:
Of the 765 consecutive pediatric cardiac surgeries, 597 were included in the analysis based on the exclusion criteria. Of these, 17 (2.8%) developed SSI (3 SiSSI cases, 2 DiSSI cases and 12 mediastinitis cases), with Staphylococcus aureus as the major pathogen. Univariate analysis revealed that low preoperative serum protein ( P = 0.049) and low serum albumin levels ( P = 0.023) were risk factors for the development of SSI. No findings suggested impaired hepatic synthesis, inflammatory disease or protein loss from the kidney or intestinal tract. We concluded that malnutrition caused low serum protein and albumin levels.
Conclusions:
Low preoperative serum protein and albumin levels are risk factors for SSI development of SSI. Nutritional status should be regularly assessed in children scheduled for cardiac surgery, and interventions, such as nutritional guidance, should be considered if malnutrition is suspected.
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