Suvorov V V, Zaitsev V V, Gvozd E M
Department of Surgical Diseases of Children, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
Heliyon. 2024 Apr 20;10(9):e29991. doi: 10.1016/j.heliyon.2024.e29991. eCollection 2024 May 15.
Sternal infection is one of the most challenging complications to manage after heart surgery. The aim of our study is to evaluate the effectiveness of a developed algorithm for preventing sternal infection in pediatric patients after surgery for congenital heart disease (CHD).
We conducted a single-center study examining the treatment of 478 children with CHD. Patients were divided into 2 groups, taking into account the application of a developed management algorithm. A multivariate logistic regression analysis was used to identify the factors influencing the development of sternal infection following heart surgery using median sternotomy.
A developed algorithm was applied in 308 children. In total, there were 16 cases of sternal infection (3.34 %) across both groups. Deep wound infection developed in 6 patients (1.26 %). Sternal infection developed in 2 children (0.65 %) in the first group (in which the algorithm was applied) and 14 children (8.2 %) in the second group. Deep sternal infection developed in 1 patient in the first group (0.33 %) and in 5 patients in the second group (2.94 %). As a result, perioperative risk factors as postoperative resternotomy (OR 23.315; p < 0.001), delayed sternal closure (OR 9.087; p = 0.003), development of acute renal failure (OR 5.322; p = 0.018) were associated with increased risk of infection and application of the developed algorithm resulted in a significant reduction in risk (OR 0.032; p < 0.001).
The suggested method for the prevention of sternal infection has significantly reduced the incidence of sternal infection after cardiac surgery in children less than 1 year of age. In patients with moderate to high risk for surgical site infection, surgeons can enhance wound healing and prevent wound infections with simple, inexpensive, and readily available tools and techniques. Surgical aspects, topical use of antibiotics, prevention of peripheral vasoconstriction, maintenance of normal oxygen delivery rates, and an individual approach to intensive care are essential.
胸骨感染是心脏手术后最难处理的并发症之一。我们研究的目的是评估一种针对先天性心脏病（CHD）患儿术后预防胸骨感染所制定算法的有效性。
我们开展了一项单中心研究，对478例CHD患儿的治疗情况进行检查。根据所制定管理算法的应用情况，将患者分为两组。采用多因素逻辑回归分析来确定影响经正中胸骨切开术心脏手术后胸骨感染发生的因素。
308例患儿应用了所制定的算法。两组中共有16例胸骨感染（3.34%）。6例患者发生深部伤口感染（1.26%）。第一组（应用算法的组）有2例患儿（0.65%）发生胸骨感染，第二组有14例患儿（8.2%）发生胸骨感染。第一组有1例患者（0.33%）发生深部胸骨感染，第二组有5例患者（2.94%）发生深部胸骨感染。结果显示，围手术期危险因素如术后再次开胸手术（比值比[OR]23.315；p<0.001）、胸骨延迟闭合（OR 9.087；p = 0.003）、急性肾衰竭的发生（OR 5.322；p = 0.018）与感染风险增加相关，而应用所制定的算法可显著降低风险（OR 0.032；p<0.001）。
所建议的预防胸骨感染方法显著降低了1岁以下儿童心脏手术后胸骨感染的发生率。对于手术部位感染风险为中到高的患者，外科医生可以使用简单、廉价且容易获得的工具和技术来促进伤口愈合并预防伤口感染。手术方面、局部使用抗生素、预防外周血管收缩、维持正常氧输送率以及个体化的重症监护方法至关重要。
