Nelson-McMillan Kristen, Hornik Christoph P, He Xia, Vricella Luca A, Jacobs Jeffrey P, Hill Kevin D, Pasquali Sara K, Alejo Diane E, Cameron Duke E, Jacobs Marshall L
Departments of Anesthesia and Critical Care Medicine, and Pediatrics, Division of Pediatric Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina.
Ann Thorac Surg. 2016 Nov;102(5):1565-1572. doi: 10.1016/j.athoracsur.2016.08.081. Epub 2016 Oct 6.
Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk.
Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included. Primary outcome was occurrence of infection complication, defined as one or more of the following: endocarditis, pneumonia, wound infection, wound dehiscence, sepsis, or mediastinitis. Multivariable regression models were fit to assess association of infection complication with: duration of SLO (days), location of DSC procedure (operating room versus elsewhere), and patient and procedural factors.
Of 6,127 index operations with SLO at 100 centers, median age and weight were 8 days (IQR, 5-24) and 3.3 kg (IQR, 2.9-3.8); 66% of operations were STAT morbidity category 4 or 5. At least one infection complication occurred in 18.7%, compared with 6.6% among potentially eligible neonates and infants without SLO. Duration of SLO (median, 3 days; IQR, 2-5) was associated with an increased rate of infection complications (p < 0.001). Location of DSC procedure was operating room (16%), intensive care unit (67%), or other (17%). Location of DSC was not associated with rate of infection complications (p = 0.45).
Rate of occurrence of infectious complications is high among infants with sternum left open following cardiac surgery. Longer duration of SLO is associated with increased infection complications.
延迟胸骨闭合（DSC）常用于优化新生儿和婴儿心脏手术后的血流动力学稳定性。我们假设胸骨开放（SLO）的持续时间与感染并发症发生率相关，并且胸骨闭合的位置可能会降低感染风险。
纳入在STS先天性心脏病手术数据库中心（2007年至2013年）接受体外循环和DSC的初次手术且数据质量充足的婴儿（年龄≤365天）。主要结局是感染并发症的发生，定义为以下一种或多种：心内膜炎、肺炎、伤口感染、伤口裂开、败血症或纵隔炎。采用多变量回归模型评估感染并发症与以下因素的关联：SLO持续时间（天）、DSC手术位置（手术室与其他地方）以及患者和手术因素。
在100个中心进行的6127例有SLO的初次手术中，中位年龄和体重分别为8天（四分位间距，5 - 24）和3.3千克（四分位间距，2.9 - 3.8）；66%的手术属于STAT发病率类别4或5。18.7%的患者发生了至少一种感染并发症，而在没有SLO的潜在合格新生儿和婴儿中这一比例为6.6%。SLO持续时间（中位，3天；四分位间距，2 - 5）与感染并发症发生率增加相关（p < 0.001）。DSC手术位置为手术室（16%）、重症监护病房（67%）或其他（17%）。DSC位置与感染并发症发生率无关（p = 0.45）。
心脏手术后胸骨开放的婴儿感染并发症发生率较高。SLO持续时间越长，感染并发症增加。
