Department of Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany.
PLoS One. 2022 May 23;17(5):e0267985. doi: 10.1371/journal.pone.0267985. eCollection 2022.
Delayed sternal closure is a routine procedure to reduce hemodynamic and respiratory instability in pediatric patients following cardiac surgery, particularly in neonates and infants. In this setting, the possible links between sternal wound infection and delayed sternal closure are still a matter of debate. As a part of our routine, there was a low threshold for delayed sternal closure, so we reviewed our experience with sternal wound infections with a focus on potentially related perioperative risk factors, particularly delayed sternal closure.
We retrospectively identified 358 operated neonates (37%) and infants (mean age 3.6 months) in our local congenital heart disease database between January 2013 and June 2017. Potential risk factors for sternal wound infections, such as age, gender, complexity (based on Aristotle- and STS-EACTS mortality category), reoperation, use of cardiopulmonary bypass, extracorporeal membrane oxygenation, mortality and delayed sternal closure (163/358, 46%), were subjected to uni- and multivariate analysis.
A total of 26/358 patients (7.3%) developed a superficial sternal wound infection. There were no deep sternal wound infections, no mediastinitis or sepsis. Applying univariate analysis, the prevalence of sternal wound infections was related to younger age, more complex surgery and delayed sternal closure. However, in multivariate analysis, sternal wound infection was only associated with delayed sternal closure (p = 0.013, odds ratio 8.6). Logistic regression revealed the prevalence of delayed sternal closure to be related to younger age, complexity, and the use of extracorporeal membrane oxygenation.
In patients younger than one year, sternal wound infections are clearly related to delayed sternal closure. However, in our cohort, all sternal wound infections were superficial and acceptable, considering the improved postoperative hemodynamic stability.
在心脏手术后，尤其是新生儿和婴儿中，延迟胸骨闭合是一种常规程序，可减少血液动力学和呼吸不稳定。在这种情况下，胸骨伤口感染与延迟胸骨闭合之间的可能联系仍存在争议。作为我们常规工作的一部分，延迟胸骨闭合的门槛较低，因此我们回顾了我们在胸骨伤口感染方面的经验，重点关注潜在相关的围手术期危险因素，特别是延迟胸骨闭合。
我们在当地先天性心脏病数据库中回顾性地确定了 2013 年 1 月至 2017 年 6 月之间接受手术的 358 例新生儿（37％）和婴儿（平均年龄 3.6 个月）。胸骨伤口感染的潜在危险因素，如年龄、性别、复杂性（基于亚里士多德和 STS-EACTS 死亡率分类）、再次手术、体外循环、体外膜氧合、死亡率和延迟胸骨闭合（163/358，46％），进行了单变量和多变量分析。
共有 26/358 例患者（7.3％）发生浅表胸骨伤口感染。无深部胸骨伤口感染、纵隔炎或败血症。应用单变量分析，胸骨伤口感染的发生率与年龄较小、手术更复杂和延迟胸骨闭合有关。然而，在多变量分析中，胸骨伤口感染仅与延迟胸骨闭合有关（p=0.013，优势比 8.6）。逻辑回归显示，延迟胸骨闭合的发生率与年龄较小、复杂性和体外膜氧合的使用有关。
在年龄小于 1 岁的患者中，胸骨伤口感染与延迟胸骨闭合明显相关。然而，在我们的队列中，所有胸骨伤口感染均为浅表且可接受的，考虑到术后血液动力学稳定性的提高。
