Minimization of Surgical Site Infections in Patients With Delayed Sternal Closure After Pediatric Cardiac Surgery

2019 ◽  
Vol 10 (4) ◽  
pp. 400-406 ◽  
Author(s):  
Mouhammad Yabrodi ◽  
Jeremy L. Hermann ◽  
John W. Brown ◽  
Mark D. Rodefeld ◽  
Mark W. Turrentine ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Recent Literature ◽  
Surgical Site Infections ◽  
Congenital Heart Surgery ◽  
Infectious Complications ◽  
Pediatric Cardiac Surgery ◽  
Clinical Sepsis ◽  
Sternal Closure ◽  
Delayed Sternal Closure

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.

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

2017 ◽  
Vol 8 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Wound Infections ◽  
Improvement Project ◽  
Sternal Closure ◽  
Increased Risk ◽  
Delayed Sternal Closure ◽  
Sternal Wound Infections

Background: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Methods: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Results: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. Conclusion: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Efforts to Reduce Infections in Delayed Sternal Closure Patients: A Survey of Pediatric Practice

2020 ◽  
Vol 11 (3) ◽  
pp. 310-315
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
S. Adil Husain
Keyword(s):  
Cardiac Surgery ◽  
Wound Care ◽  
The United States ◽  
Pediatric Cardiac Surgery ◽  
Institutional Practices ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Cardiac Bypass ◽  
The Mean ◽  
Question Survey

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.

Staged Delayed Sternal Closure Using a Binder Clip After Pediatric Cardiac Surgery

2016 ◽  
Vol 31 (7) ◽  
pp. 464-466 ◽  
Author(s):  
Tai Fuchigami ◽  
Masahiko Nishioka ◽  
Toru Akashige ◽  
Shotaro Higa ◽  
Nobuhiro Nagata
Keyword(s):  
Cardiac Surgery ◽  
Pediatric Cardiac Surgery ◽  
Sternal Closure ◽  
Delayed Sternal Closure

Outcomes of Primary versus Secondary Delayed Sternal Closure in Pediatric Cardiac Surgery

2021 ◽  
Author(s):  
Mohamed F. Elsisy ◽  
Joseph A. Dearani ◽  
Juan A. Crestanello ◽  
Elena M. Ashikhmina ◽  
Charlotte S. Van Dorn ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pediatric Cardiac Surgery ◽  
Sternal Closure ◽  
Delayed Sternal Closure

scholarly journals Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

2017 ◽  
Vol 8 (4) ◽  
pp. 435-439 ◽  
Author(s):  
Carlos A. Villa-Hincapie ◽  
Marisol Carreno-Jaimes ◽  
Carlos E. Obando-Lopez ◽  
Jaime Camacho-Mackenzie ◽  
Juan P. Umaña-Mallarino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Congenital Heart Surgery ◽  
Pediatric Cardiac Surgery ◽  
Cross Clamp Time

Background: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. Methods: Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. Results: In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. Conclusions: Resternotomy in pediatric cardiac surgery is a safe procedure in our center.

scholarly journals Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure

2013 ◽  
Vol 146 (2) ◽  
pp. 326-333 ◽  
Author(s):  
Erika E. Harder ◽  
Michael G. Gaies ◽  
Sunkyung Yu ◽  
Janet E. Donohue ◽  
David A. Hanauer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Surgical Site Infection ◽  
Pediatric Cardiac Surgery ◽  
Site Infection ◽  
Sternal Closure ◽  
Delayed Sternal Closure
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