Department of Surgery, University of Colorado School of Medicine, 12605 E 16th Ave, Aurora, CO, 80045, USA.
Department of Cardiology and Cardiothoracic Surgery, Children's Hospital of Colorado, Aurora, CO, USA.
Pediatr Cardiol. 2024 Aug;45(6):1284-1288. doi: 10.1007/s00246-022-03088-4. Epub 2022 Dec 30.
Surgical site infections (SSI) following congenital heart surgery (CHS) remain a significant source of morbidity. Delayed sternal closure (DSC) is often required to minimize the potential for hemodynamic instability. The purpose of this study was to determine the incidence of SSI among patients undergoing DSC versus primary chest closure (PCC) and to define a potential inflection point for increased risk of SSI as a function of open chest duration (OCD).A retrospective review of our institutional Society of Thoracic Surgeons dataset is to identify patients undergoing CHS at our institution between 2015 and 2020. Incidences of SSI were compared between DSC and PCC patients. DSC patients were evaluated to determine the association of OCD and the incidence of SSI.2582 operations were performed at our institution between 2015 and 2020, including 195 DSC and 2387 PCC cases. The incidence of SSI within the cohort was 1.8% (47/2,582). DSC patients had significantly higher incidences of SSI (17/195, 8.7%) than PCC patients (30/2387, 1.3%, p < 0.001). Further, patients with an OCD of four or more days had a significantly higher incidence of SSI (11/62, 17.7%, p = 0.006) than patients with an OCD less than 4 days (6/115, 5.3%).The incidence of SSI following CHS is higher in DSC patients compared to PCC patients. Prolonged OCD of 4 days or more significantly increases the risk of SSI and represents a potentially modifiable risk factor for SSI predisposition. These data support dedicated, daily post-operative assessment of candidacy for chest closure to minimize the risk of SSI.
先天性心脏病手术后（CHS）的手术部位感染（SSI）仍然是发病率的重要来源。为了最大限度地减少潜在的血流动力学不稳定，通常需要延迟胸骨闭合（DSC）。本研究的目的是确定与直接胸骨闭合（DSC）相比，行原发性胸廓闭合（PCC）的患者中 SSI 的发生率，并确定随着开胸时间（OCD）的延长，SSI 风险增加的潜在拐点。
对我院机构胸外科医师协会数据集进行回顾性分析，以确定 2015 年至 2020 年期间在我院行 CHS 的患者。比较 DSC 和 PCC 患者的 SSI 发生率。评估 DSC 患者以确定 OCD 与 SSI 发生率的关系。
2015 年至 2020 年期间，我院共进行了 2582 例手术，其中 DSC 患者 195 例，PCC 患者 2387 例。该队列中 SSI 的发生率为 1.8%（47/2582）。DSC 患者的 SSI 发生率明显高于 PCC 患者（17/195，8.7%）（30/2387，1.3%，p<0.001）。此外，OCD 持续时间为 4 天或以上的患者 SSI 发生率明显高于 OCD 持续时间小于 4 天的患者（11/62，17.7%，p=0.006）（6/115，5.3%）。
与 PCC 患者相比，CHS 后 DSC 患者的 SSI 发生率更高。OCD 持续时间超过 4 天显著增加 SSI 的风险，是 SSI 易感性的潜在可调节危险因素。这些数据支持术后每天进行专门的评估，以确定行胸廓闭合术的适应证，从而降低 SSI 的风险。
