Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115-5737, USA.
Ann Thorac Surg. 2010 Jun;89(6):1833-41; discussion 1841-2. doi: 10.1016/j.athoracsur.2009.08.081.
We sought to identify risk factors for surgical site infections (SSI) in children undergoing cardiac surgery.
A matched case-control study was conducted in the Children's Hospital Boston Cardiovascular Program. Surgical site infections were identified for 3 years (2004 to 2006). We identified two randomly selected control patients who underwent cardiac surgery within 7 days of each index case. Univariate and multivariate conditional logistic regression analyses were used to identify risk factors for SSI. In a secondary analysis, risk factors for organ space SSI (mediastinitis) were sought. Secondary analyses were also conducted using only those variables known preoperatively.
Seventy-two SSI and 144 controls were included. Independent risk factors for any type of SSI were age younger than 1 year (adjusted odds ratio, 2.28; 95% confidence interval, 1.18 to 4.39) and duration of cardiopulmonary bypass greater than 105 minutes (adjusted odds ratio, 1.92; 95% confidence interval, 1.02 to 3.62). Independent risk factors for organ space SSI were aortic cross-clamp time greater than 85 minutes (adjusted odds ratio, 5.61; 95% confidence interval, 1.06 to 29.67) and postoperative exposure to at least three separate red blood cell transfusions (adjusted odds ratio, 7.87; 95% confidence interval, 1.63 to 37.92). When only those potential risk factors known preoperatively were considered, age younger than 1 year independently predicted the subsequent development of any type of SSI, and preoperative hospitalization independently predicted the subsequent development of organ space SSI.
Younger patients undergoing longer surgical procedures and those requiring more postoperative blood transfusions are at greatest risk for SSI. Additional preventive strategies, including restrictive blood transfusion policies, warrant further investigation.
我们旨在确定行心脏手术的儿童发生手术部位感染（SSI）的风险因素。
在波士顿儿童医院心血管项目中进行了一项匹配病例对照研究。在 3 年（2004 年至 2006 年）中确定了手术部位感染。我们随机选择了在每个指数病例后 7 天内接受心脏手术的两名对照患者。采用单变量和多变量条件逻辑回归分析确定 SSI 的风险因素。在二次分析中，我们试图寻找器官间隙 SSI（纵隔炎）的风险因素。还进行了仅使用术前已知变量的二次分析。
共纳入 72 例 SSI 和 144 例对照。任何类型 SSI 的独立危险因素是年龄小于 1 岁（调整后的优势比，2.28；95%置信区间，1.18 至 4.39）和体外循环时间超过 105 分钟（调整后的优势比，1.92；95%置信区间，1.02 至 3.62）。器官间隙 SSI 的独立危险因素是主动脉阻断时间超过 85 分钟（调整后的优势比，5.61；95%置信区间，1.06 至 29.67）和术后接受至少 3 次单独的红细胞输血（调整后的优势比，7.87；95%置信区间，1.63 至 37.92）。当仅考虑术前已知的潜在危险因素时，年龄小于 1 岁独立预测任何类型 SSI 的后续发展，而术前住院独立预测器官间隙 SSI 的后续发展。
手术时间较长且术后需要更多输血的年轻患者发生 SSI 的风险最大。包括限制性输血政策在内的其他预防策略值得进一步研究。
