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Suvorov V, Zaitsev V, Gvozd E. Efficiency of an algorithm for the prevention of sternal infection after cardiac surgery in children under 1 year of age: A single-center retrospective study. Heliyon 2024; 10:e29991. [PMID: 38694077 PMCID: PMC11058895 DOI: 10.1016/j.heliyon.2024.e29991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background 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). Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- V.V. Suvorov
- Department of Surgical Diseases of Children, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - V.V. Zaitsev
- Department of Surgical Diseases of Children, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - E.M. Gvozd
- Department of Surgical Diseases of Children, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
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Sternal Wound Management in Pediatric Cardiac Surgical Patients: A Novel Strategic Interprofessional Approach: Erratum. Adv Skin Wound Care 2023; 36:1. [PMID: 36179317 DOI: 10.1097/01.asw.0000891032.57796.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jha NK, Shafique M, Thomas R, Pangilinan Cruz S, Tariq G, Kiraly L. Sternal Wound Management in Pediatric Cardiac Surgical Patients: A Novel Strategic Interprofessional Approach. Adv Skin Wound Care 2023; 36:259-266. [PMID: 37079789 DOI: 10.1097/01.asw.0000924128.52669.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Information on sternal wound management in children after cardiac surgery is limited. The authors formulated a pediatric sternal wound care schematic incorporating concepts of interprofessional wound care and the wound bed preparation paradigm including negative-pressure wound therapy and surgical techniques to expedite and streamline wound care in children. METHODS Authors assessed knowledge about sternal wound care among nurses, surgeons, intensivists, and physicians in a pediatric cardiac surgical unit regarding the latest concepts such as wound bed preparation, NERDS and STONEES criteria for wound infection, and early use of negative-pressure wound therapy or surgery. Management pathways for superficial and deep sternal wounds and a wound progress chart were prepared and introduced in practice after education and training. RESULTS The cardiac surgical unit team members demonstrated a lack of knowledge about the current concepts of wound care, although this improved after education. The newly proposed management pathway/algorithm for superficial and deep sternal wounds and a wound progress assessment chart were introduced into practice. Results in 16 observed patients were encouraging, leading to complete healing and no mortality. CONCLUSIONS Managing pediatric sternal wounds after cardiac surgery can be streamlined by incorporating evidence-based current wound care concepts. In addition, the early introduction of advanced care techniques with appropriate surgical closure further improves outcomes. A management pathway for pediatric sternal wounds is beneficial.
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Affiliation(s)
- Neerod Kumar Jha
- At Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, Neerod Kumar Jha, MD, is Pediatric Cardiac Surgeon; Muhammad Shafique, MD, is Specialist, Internal Medicine; Raisy Thomas, BSc, is Clinical Nurse Educator; Salvacion Pangilinan Cruz, MSc, is Charge Nurse, Wound Care; Gulnaz Tariq, MSc, is Nursing Officer, Wound Care Department; and Laszlo Kiraly, MD, is Pediatric Cardiac Surgeon
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Glenn ET, Harman JR, Marietta J, Lake J, Bailly DK, Ou Z, Griffiths ER, Ware AL. Impact of a Surgical Wound Infection Prevention Bundle in Pediatric Cardiothoracic Surgery. Ann Thorac Surg 2023; 115:126-134. [PMID: 36126719 DOI: 10.1016/j.athoracsur.2022.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/26/2022] [Accepted: 08/29/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this project was to decrease the incidence of surgical wound infection (SWI) to <1.5% in our pediatric cardiothoracic surgery patients using a prevention bundle and quality improvement process. METHODS An SWI prevention bundle addressing preoperative, intraoperative, and postoperative risks was implemented. The primary outcome was SWI based on Society of Thoracic Surgeons criteria (superficial, deep, or mediastinitis). Novel aspects of the bundle included standardization of surgical closure and wound coverage for 14 days with a negative pressure dressing or a silicone dressing. Data were collected from January 2017 to November 2021; bundle intervention began in December 2019. SWIs were tracked using a g-chart. Preintervention and postintervention cohorts were compared by standard descriptive statistics. There were no changes in SWI tracking methods during the study. RESULTS During the study, 1159 individuals underwent 1768 surgical interventions. Preintervention (n = 931) and postintervention (n = 837) groups were clinically similar, with fewer neonatal surgeries in the postintervention group. SWI decreased in all patients (preintervention period: 1 SWI per 22 surgeries; postintervention period: 1 SWI per 62.6 surgeries) and in neonates (preintervention period: 1 SWI per 12 surgeries; postintervention period: 1 SWI per 26.7 surgeries). Special cause variation was achieved in the entire cohort by March 2021 and in neonates by April 2021. Decreases in SWI occurred in superficial and deep wounds but not in mediastinitis. Annual rate of total SWIs decreased from 2.83% in 2019 to 1.15% in 2021. Intensive care unit and hospital length of stay did not change. CONCLUSIONS We demonstrated a reduction in SWI rates after implementing an SWI prevention bundle including standardized surgical closure and prolonged wound protection.
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Affiliation(s)
- Emilee T Glenn
- Heart Center, Intermountain Primary Children's Hospital, Salt Lake City, Utah.
| | - Jeremy R Harman
- Heart Center, Intermountain Primary Children's Hospital, Salt Lake City, Utah
| | - Jennifer Marietta
- Heart Center, Intermountain Primary Children's Hospital, Salt Lake City, Utah
| | - Jason Lake
- Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah
| | - David K Bailly
- Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Eric R Griffiths
- Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Adam L Ware
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
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Martynov I, Gosemann JH, Hofmann AD, Kuebler JF, Madadi-Sanjani O, Ure BM, Lacher M. Vacuum-assisted closure (VAC) prevents wound dehiscence following posterior sagittal anorectoplasty (PSARP): An exploratory case-control study. J Pediatr Surg 2021; 56:745-749. [PMID: 32778448 DOI: 10.1016/j.jpedsurg.2020.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 07/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Wound dehiscence (WD) of the anocutaneous anastomosis or perineal body after posterior sagittal anorectoplasty (PSARP) is common. We aimed to evaluate the efficacy of a perineal vacuum-assisted closure (VAC) for prevention of WD following repair of anorectal malformations (ARM) with rectoperineal and rectovestibular fistula. METHODS A retrospective dual-center case-control study of children undergoing PSARP without colostomy between 2011 and 2019 was performed. The VAC group received preoperative bowel preparation (PBP), postoperative application of a VAC, loperamide (only Location A), intravenous antibiotics (IA), and total parenteral nutrition (TPN). The non-VAC group underwent PBP, loperamide (Location A), IA, and TPN without VAC. Primary outcome was WD at the anocutaneous anastomosis or reconstructed perineal body within the first 14 days after surgery. RESULTS The study population included 18 patients (VAC group) and 20 children (non-VAG group) with rectoperineal and rectovestibular fistula. The incidence of WD in the VAC group was 0% compared to 25% in the non-VAC group (0/18 vs. 5/20, p = 0.04). No VAC related complications occurred. CONCLUSION Postoperative application of a VAC embedded in a perioperative treatment protocol has the potential to prevent wound dehiscence of the neoanus and reconstructed perineal body following PSARP. TYPE OF STUDY Case-control study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany.
| | | | | | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | | | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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Wu Y, Wang J, Dai J, Wang G, Li H, Li Y, Wu C, Wei G. Is vacuum-assisted closure therapy feasible for children with deep sternal wound infection after cardiac surgery? The pooling results from current literature. Artif Organs 2021; 45:827-837. [PMID: 33569832 DOI: 10.1111/aor.13936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/29/2022]
Abstract
Vacuum-assisted closure (VAC) has been used for children with deep sternal wound infections (DSWI); however, the safety and efficiency have not been determined. A meta-analysis was performed for outcomes of VAC therapy in children with DSWI after cardiac surgery. Electronic databases, including PubMed, Scopus, and Cochrane Library CENTRAL were searched systematically from January 1990 to October 2020 for the literature which reported the outcomes of VAC therapy for children with DSWI after cardiac surgery. Meta-regression and subgroup analyses were performed to find risk factors for prolonged length of VAC therapy and hospital stay. Eleven studies were included in this study, involving 217 subjects. VAC therapy was performed due to mediastinitis after congenital heart diseases (CHD) repair. In children with DSWI after cardiac surgery, length of VAC therapy, and hospital stay were 11.1 days (95% CI, 9.6-12.5 days) and 29.8 days (95% CI, 22.8-36.9 days), respectively. Incidence of infectious and wound-related complications was 8.5% (95% CI, 4.1%-13.0%). Overall mortality in this setting was 5.8% (95% CI, 2.5%-9.1%). In conclusion, in children with DSWI after cardiac surgery, length of VAC therapy and hospital stay were 11.1 and 29.8 days, respectively. Overall mortality was 5.8%. Although not significant, delayed chest closure, complex CHD, and Gram-negative bacilli/fungal infections may potentially contribute to prolonged duration of VAC treatment.
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Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Junke Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guanghui Wei
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Jo T, Hur J, Kim EK. Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach. Thorac Cardiovasc Surg 2021; 70:56-64. [PMID: 33540426 DOI: 10.1055/s-0040-1722733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device. METHODS Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed. RESULTS Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6-26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11-29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures. CONCLUSION We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.
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Affiliation(s)
- Taehee Jo
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Joon Hur
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Schlueer AB, Schwieger-Briel A, Theiler M, Neuhaus K, Schiestl C, Weibel L. Negative pressure wound treatment in a neonate with epidermolysis bullosa simplex severe generalized: A case report. Pediatr Dermatol 2020; 37:1218-1220. [PMID: 32892402 DOI: 10.1111/pde.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Negative pressure wound treatment (NPWT) is very useful for the treatment of chronic or deep wounds and in the setting of skin grafting. Due to the need for adhesive dressings, this treatment is rarely attempted in patients with skin fragility secondary to hereditary epidermolysis bullosa (EB). We present a neonate with EB simplex, severe generalized in a critical clinical state where NPWT was successfully applied and describe the measures taken to avoid any further skin damage. This case is of clinical importance to physicians and health care staff treating patients with this rare disease where additional therapeutic measures for the treatment of chronic wounds are scarce.
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Affiliation(s)
- Anna-Barbara Schlueer
- Department of Pediatric Dermatology, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Nursing Science, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Agnes Schwieger-Briel
- Department of Pediatric Dermatology, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Theiler
- Department of Pediatric Dermatology, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kathrin Neuhaus
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Plastic & Reconstructive Surgery, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Clemens Schiestl
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Plastic & Reconstructive Surgery, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lisa Weibel
- Department of Pediatric Dermatology, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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