Sochet Anthony A, Cartron Alexander M, Nyhan Aoibhinn, Spaeder Michael C, Song Xiaoyan, Brown Anna T, Klugman Darren
1 Division of Critical Care Medicine, Department of Pediatrics, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.
2 School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):7-12. doi: 10.1177/2150135116674467.
Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS.
We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure.
Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01).
Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.
心胸外科手术（CTS）后，0.25%至6%的儿童会发生手术部位感染（SSI）。关于小儿CTS后SSI的经济影响，尚无公开数据。我们试图确定CTS后儿童SSI所致的额外住院费用和住院时间。
我们在一个拥有26张床位的心脏重症监护病房（CICU）进行了一项回顾性配对队列研究，研究时间为2010年1月至2013年12月。通过回顾性研究确定SSI病例，并根据年龄、性别、先天性心脏病手术风险调整评分、胸外科医师协会-欧洲心胸外科协会分类、原发性心脏诊断和手术，将病例与对照按2:1进行个体配对。
在研究期间进行的981例手术中，确定了12例SSI病例。人口统计学、临床特征或术中数据无差异。与对照组相比，SSI参与者的总住院费用中位数更高（219,573美元对82,623美元，P < 0.01）。发生SSI的儿童CICU住院时间中位数更长（9天对3天，P < 0.01），住院时间（18天对8.5天，P < 0.01），机械通气时间（2天对1天，P < 0.01）和血管活性药物使用时间（4.5天对1天，P < 0.01）。
CTS后发生SSI的儿童，每例住院费用增加136,950美元，住院时间增加9.5天。SSI带来的经济负担凸显了感染控制监测、全面预防措施以及确定可改变风险因素的重要性。
