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Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy

Rohit Nallani1, Brevin J Miller2, Janelle R Noel-MacDonnell2,3

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|August 10, 2024
PubMed

Insights

Pediatric sternal wound infection (SWI) risk is higher in children with a pre-existing tracheostomy and pulmonary disease. This study highlights tracheostomy as a significant risk factor for SWI following sternotomy in children.

Area of Science:

  • Pediatric surgery
  • Infectious disease
  • Critical care medicine

Background:

  • Sternal wound infection (SWI) is a rare but serious complication after pediatric sternotomy.
  • Pre-existing tracheostomy is an understudied risk factor for SWI in children.
  • Identifying risk factors is crucial for preventing SWI and improving surgical outcomes.

Purpose of the Study:

  • To determine the impact of pre-existing tracheostomy on the incidence of SWI in pediatric patients undergoing sternotomy.
  • To investigate other potential risk factors, such as underlying pulmonary disease, associated with SWI.
  • To compare SWI rates between children with and without a pre-existing tracheostomy.

Main Methods:

  • Retrospective cohort study over 12 years at a tertiary children's hospital.
  • Matched comparison of children with pre-existing tracheostomy undergoing sternotomy (TPS) to those without.
  • Data collected included demographics, comorbidities, surgical details, SWI diagnosis, and outcomes.

Main Results:

  • The incidence of SWI was significantly higher in children with a tracheostomy (22.5%) compared to those without (2.5%).
  • Children with tracheostomy and underlying pulmonary disease showed a greater risk of SWI.
  • Infections in the tracheostomy group were more frequently caused by Pseudomonas aeruginosa and polymicrobial growth.

Conclusions:

  • Pre-existing tracheostomy and underlying pulmonary disease are significant risk factors for SWI in pediatric sternotomy patients.
  • Further research is needed to elucidate contributing factors and develop strategies to mitigate SWI risk in this population.
  • Early identification and management of risk factors may improve outcomes for children undergoing sternotomy.
Abstract

Keywords:
pediatric sternotomypediatric tracheotomysternal wound infectionsurgical outcomessurgical site infection

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