Pediatric Critical Care, Department of Pediatrics, UT Health San Antonio, TX, USA.
Pediatric Critical Care, UMKC School of Medicine, Kansas City, MO, USA.
World J Pediatr Congenit Heart Surg. 2020 May;11(3):310-315. doi: 10.1177/2150135120907372.
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.
A 33 question survey on institutional practices was sent to chief surgeons at pediatric cardiac surgery programs in the United States.
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%; = .015). Patients in programs with feeding protocols had fewer infections (5.7% vs 14.8%; = .008).
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.
心脏手术后胸骨未完全闭合的儿科患者存在更高的胸骨伤口感染（SWI）风险。这些感染给项目、支付方和患者及其家庭带来了巨大的经济负担。尽管个别项目已经努力降低延迟性胸骨闭合（DSC）患者的感染率，但目前尚无针对预防措施的既定指南。本研究旨在确定儿科心脏手术项目预防 DSC 患者感染的实践情况，以及预防措施是否与感染减少相关。
我们向美国儿科心脏手术项目的首席外科医生发送了一份关于机构实践的 33 个问题的调查。
28 个（35%）外科项目做出了回应。2016 年，各项目平均开展的儿科心脏体外循环手术数量为 227 例（范围：69-872 例）。数据代表了 6484 名<18 岁接受心脏手术的患者，其中 807 例（12%）患者接受了 DSC。所有患者中有 158 例（2.4%）和 DSC 患者中有 51 例（6.3%）发生了 SWI。接受术前沐浴的 DSC 患者发生感染的可能性较低（5.9% vs 15.8%； =.015）。有喂养方案的项目中患者感染率较低（5.7% vs 14.8%； =.008）。
这项对儿童心脏手术项目的调查结果描述了他们为降低 DSC 患者感染率而采取的实践措施。需要开展一项关于伤口护理和闭合技术的多中心项目，以解决这一代价高昂的并发症问题。
