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

Abstract

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.

A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

“…Other limitations of the current study include inconsistent data collection related to the timing of infections, dressing types, and other bedside practices and procedures that may influence infections rates in the setting of DSC. 43 The number of additional procedures such as chest explorations and washouts has been associated with infection risk in patients undergoing DSC, 6 but this information was generally unavailable in the included studies. Reason for DSC was also rarely captured by the individual studies.…”

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

“…Another recent study investigated the incidence of superficial SSIs in children who underwent cardiac surgery with delayed sternal closure (DSC), a surgical strategy which is frequently used in children to prevent post-surgical complications [ 23 ]. This study reported a 2.4% superficial SSI rate in the study cohort, with a statistically significant difference between those patients who underwent DSC (6.3%) and those who did not (1.9%).…”

“…This study reported a 2.4% superficial SSI rate in the study cohort, with a statistically significant difference between those patients who underwent DSC (6.3%) and those who did not (1.9%). The same study also evaluated the different outcomes in terms of SSI rates among patients whose surgical wounds were medicated with wet to dry dressings and patients whose surgical wounds were medicated using negative pressure dressings: the result showed a nearly statistically significant difference ( p = 0.054), as negative pressure dressings were associated with a lower surgical site infection risk (6.4 vs. 15.7%) [ 23 ].…”

“…Overall, the available literature showed that SSIs are a frequent event in children, leading to relevant complications and prolonged hospital stays [ 30 , 31 ]. Table 1 summarize SSI rates in pediatric and neonatal studies [ 17 , 18 , 19 , 20 , 22 , 23 , 25 , 26 , 27 , 29 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], whereas Table 2 summarize the main risk factors for SSI [ 17 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”