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Open Chest Duration Following Congenital Cardiac Surgery Increases Risk for Surgical Site Infection

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Abstract

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.

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References

  1. Harder Erika E et al (2013) Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J thorac cardiovasc surg 146(2):326–333

    Article  Google Scholar 

  2. Riahi Mohammad et al (1975) Cardiac compression due to closure of the median sternotomy in open heart surgery. Chest 67(1):113–114

    Article  Google Scholar 

  3. Fanning WJ, Vasko JS, Kilman JW (1987) Delayed sternal closure after cardiac surgery. Ann Thorac Surg 44(2):169–172

    Article  Google Scholar 

  4. Jögi P, Werner O (1985) Hemodynamic effects of sternum closure after open-heart surgery in infants and children. Scand J Thorac Cardiovasc Surg 19(3):217–220

    Article  Google Scholar 

  5. Costello John M et al (2010) Risk factors for surgical site infection after cardiac surgery in children. Annals thorac surg 89(6):1833–1842

    Article  Google Scholar 

  6. Levy I et al (2003) Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 53(2):111–116

    Article  Google Scholar 

  7. Holzmann-Pazgal Galit et al (2008) Case-control study of pediatric cardiothoracic surgical site infections. Infect Control Hosp Epidemiol 29(1):76–79

    Article  Google Scholar 

  8. Shah Samir S et al (2007) Bloodstream infections after median sternotomy at a children’s hospital. J thorac cardiovasc surg 133(2):435–440

    Article  Google Scholar 

  9. Al-Sehly AA et al (2005) Pediatric poststernotomy mediastinitis. Annals thorac surg 80(6):2314–2320

    Article  Google Scholar 

  10. Nelson-McMillan K et al (2016) Delayed sternal closure in infant heart surgery—the importance of where and when: an analysis of the STS congenital heart surgery database. Annals thorac surg 102(5):1565–1572

    Article  Google Scholar 

  11. Adler AL et al (2014) Significance of positive mediastinal cultures in pediatric cardiovascular surgical procedure patients undergoing delayed sternal closure. Annals thorac surg 98(2):685–690

    Article  Google Scholar 

  12. Elassal AA et al (2019) Delayed sternal closure in congenital heart surgery: a risk-benefit analysis. Heart Surg Forum 22:5

    Article  Google Scholar 

  13. McElhinney DB et al (2000) Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit care med 28(4):1180–1184

    Article  Google Scholar 

  14. Boeken Udo et al (2011) Open chest management after cardiac operations: outcome and timing of delayed sternal closure. European j cardio-thorac surg 40(5):1146–1150

    Google Scholar 

  15. Furnary AP et al (1992) Prolonged open sternotomy and delayed sternal closure after cardiac operations. The Annals thorac surg 54(2):233–239

    Article  Google Scholar 

  16. Yang Y, Wang J, Cai L, Peng W, Mo X (2021) Surgical site infection after delayed sternal closure in neonates with congenital heart disease: retrospective case-control study. Ital J Pediatr 47(1):182. https://doi.org/10.1186/s13052-021-01138-w

    Article  Google Scholar 

  17. Olsen MA et al (2002) The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J thorac cardiovasc surg 124(1):136–145

    Article  Google Scholar 

  18. Yabrodi M et al (2019) Minimization of surgical site infections in patients with delayed sternal closure after pediatric cardiac surgery. World J Pediatr Congenit Heart Surg 10(4):400–406

    Article  Google Scholar 

  19. Riphagen S, McDougall M, Tibby SM et al (2005) “Early” delayed sternal closure following pediatric cardiac surgery. Ann Thorac Surg 80(2):678–684

    Article  Google Scholar 

  20. Tabbutt S, Duncan BW, McLaughlin D, Wessel DL, Jonas RA, Laussen PC (1997) Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 113(5):886–893

    Article  Google Scholar 

  21. Johnson JN, Jaggers J, Li S et al (2010) Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 139(5):1205–1210

    Article  Google Scholar 

  22. Iyer RS, Jacobs JP, de Leval MR, Stark J, Elliot MJ (1997) Outcomes after delayed sternal closure in pediatric heart operations: a 10-year experience. Ann thorac surg 63(2):489–491

    Article  Google Scholar 

  23. Kennedy III, John T et al (2021) A Systematic review of antibiotic prophylaxis for delayed sternal closure in children. World J Pediatr Congenit Heart Surg 12(1):93–102

    Article  Google Scholar 

  24. Silvetti S et al (2020) Antibiotic management for delayed sternal closure following pediatric cardiac surgery: a systematic review of recent literature. Journal of cardiothoracic and vascular anesthesia. 34(5):1333–1340

    Article  Google Scholar 

  25. Jaworski R et al (2019) Antibiotic prophylaxis in pediatric cardiac surgery: where are we and where do we go? A systematic review. Surg infect 20(4):253–260

    Article  Google Scholar 

  26. Healthcare-associated infections (HAIS). Centers for disease control and prevention. https://www.cdc.gov/hai. Accessed 10 June 2021

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Funding

Authors John Iguidbashian, MD and Matthew Stone, MD are supported by funding from the Society of Thoracic Surgeons/Thoracic Surgery Foundation STS Research Award.

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Authors and Affiliations

  1. Department of Surgery, University of Colorado School of Medicine, 12605 E 16th Ave, Aurora, CO, 80045, USA

    John Iguidbashian, Zihan Feng & Kathryn L. Colborn

  2. Department of Cardiology and Cardiothoracic Surgery, Children’s Hospital of Colorado, Aurora, CO, USA

    Cindy S. Barrett, Shanna R. Newman, Marisa Harris, David N. Campbell, Max B. Mitchell, James Jaggers & Matthew L. Stone

Authors
  1. John Iguidbashian
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  2. Zihan Feng
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  7. David N. Campbell
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  9. James Jaggers
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  10. Matthew L. Stone
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Contributions

ZF, CSB, SRN, MH, MBM, JJ, MLS: conceptualization, JI, ZF, KLC, CSB, MLS: methodology, JI, ZF, KLC, CSB, SRN, MH, MLS: formal analysis and investigation, JI, ZF: writing—original draft, JI, ZF, CSB, SRN, MH, DNC, MBM, JJ, MLS: writing—review/editing, DNC, MBM, JJ, MLS: supervision.

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Correspondence to John Iguidbashian.

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Iguidbashian, J., Feng, Z., Colborn, K.L. et al. Open Chest Duration Following Congenital Cardiac Surgery Increases Risk for Surgical Site Infection. Pediatr Cardiol (2022). https://doi.org/10.1007/s00246-022-03088-4

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