Post cardiac surgery sternal wound sepsis burden, risk factors and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A five-year experience

F. Mpisane, A. Brooks, W. Basera, L. Zühlke
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Abstract

Purpose: Sternal wound infection (SWI) is associated with significant morbidity and mortality in post-operative cardiac patients. We aimed to describe the burden, risk factors and outcomes of SWI in post-operative paediatric cardiac patients at a tertiary children’s hospital. Methods: We conducted a retrospective record review of cardiac surgeries via median sternotomy over a 5-year period to identify cases of SWI. Results: Between 2011 and 2016, 1 319 patients underwent median sternotomy. Thirty four (2.6%) patients developed SWI; 18 (13%) patients developed deep sternal wound infection (DSWI), and 16 (12%) developed superficial sternal wound infections (SSWI). Twenty two (16%) of SWIs were apparent within a week postsurgery before discharge, and the remaining were readmitted post-discharge. Seven (0.5%) patients died from complications. Conclusion: Significant morbidity was associated with SWI. Furthermore, with a mortality rate of 20% in the case of DSWI, we strongly support quality improvement procedures such as the Sternal Wound Prevention Bundle (SWPB) that was introduced in late 2014. However, the rate of SWI implies that ongoing monitoring and evaluation of the SWPB is necessary and more stringent adherence to the protocol may result in better outcomes .
南非开普敦红十字战争纪念儿童医院心脏手术后胸骨伤口败血症负担、危险因素和结局:五年经验
目的:胸骨伤口感染(SWI)与心脏术后患者的发病率和死亡率相关。我们的目的是描述三级儿童医院小儿心脏术后患者SWI的负担、危险因素和结果。方法:我们对5年来通过胸骨正中切开术进行心脏手术的病例进行回顾性分析,以确定SWI病例。结果:2011年至2016年,1 319例患者行胸骨正中切开术。34例(2.6%)患者发生SWI;18例(13%)患者发生胸骨深创面感染(DSWI), 16例(12%)患者发生胸骨浅创面感染(SSWI)。22例(16%)SWIs在出院前1周内出现,其余患者出院后再次入院。7例(0.5%)患者死于并发症。结论:SWI与显著的发病率相关。此外,由于社会福利和社会发展倡议的死亡率为20%,我们强烈支持质量改进程序,如2014年底推出的胸骨伤口预防包。然而,SWI的发生率意味着对SWPB的持续监测和评估是必要的,更严格地遵守方案可能会产生更好的结果。
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