Division of Critical Care, Department of Pediatrics, Children's Hospital of Nevada, University Medical Center, 1800 W Charleston Blvd, Las Vegas, NV, 89128, USA.
Department of Pediatrics, University of Nevada at Las Vegas, Las Vegas, NV, USA.
Pediatr Cardiol. 2020 Oct;41(7):1402-1407. doi: 10.1007/s00246-020-02396-x. Epub 2020 Jun 18.
Sternal wound infections (SWI) in delayed sternal closure (DSC) patients are a healthcare burden after congenital heart surgery. There are no guidelines specific for pediatric DSC patients to prevent this costly complication. The hypothesis was that the modifications to a bundled approach for DSC patients would decrease the SWI rate. For this prospective cohort study, DSC patients were postoperatively admitted to a pediatric cardiac care unit from February 2017 to January 2018. Using a modified protocol for prevention of SWI, the infection rates pre- and post-modified protocol were compared. The primary outcome measure was SWI. Secondary outcome measures were compliance with modifications. Retrospective review of cases in pre-protocol modification era from January 1, 2014 to December 31, 2016 showed 377 pediatric cardiopulmonary bypass cases and 39 (10.4%) underwent DSC. During the post-protocol modification era, there were 129 cardiopulmonary bypass cases and 17 (13%) DSC cases. The SWI rate in DSC were 7.7% and 0% for pre-intervention and post-intervention, respectively (p = 0.52). The Bayesian confidence interval with Jeffreys prior gives a 95% confidence interval of 1.5% to 18.3% for pre-intervention and 0 to 13.5% for post-intervention. Compliance with the protocol bundle during the post protocol era was 93-100%. Although preliminary results are not statistically significant due to cohort size, the economic burden and increased LOS for each SWI is clinically significant. The early results of reduced infections for DSC patients using a modified bundle approach appear promising. Continued study and a multicenter project would be beneficial.
胸骨伤口感染（SWI）是先天性心脏病手术后延迟胸骨闭合（DSC）患者的医疗负担。目前尚无专门针对儿科 DSC 患者的指南来预防这种代价高昂的并发症。假设对 DSC 患者的捆绑式治疗方法进行修改，将降低 SWI 发生率。在这项前瞻性队列研究中，DSC 患者术后被收入儿科心脏护理病房，时间为 2017 年 2 月至 2018 年 1 月。使用预防 SWI 的改良方案，比较了改良前后方案的感染率。主要结局指标是 SWI。次要结局指标是对修改的遵守情况。回顾性分析 2014 年 1 月 1 日至 2016 年 12 月 31 日的预修改方案时期的病例，共有 377 例儿科体外循环病例，其中 39 例（10.4%）行 DSC。在修改方案后时期，有 129 例体外循环病例，其中 17 例（13%）行 DSC。DSC 的 SWI 发生率分别为干预前的 7.7%和干预后的 0%（p=0.52）。杰弗里斯先验贝叶斯置信区间给出了干预前的 95%置信区间为 1.5%至 18.3%，干预后的 0 至 13.5%。在修改后的方案时期，方案包的遵守率为 93-100%。尽管由于队列规模，初步结果没有统计学意义，但每个 SWI 的经济负担和 LOS 增加在临床上都是有意义的。使用改良捆绑式方法降低 DSC 患者感染率的早期结果令人鼓舞。继续研究和多中心项目将是有益的。
