Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Abstract

Background In pediatric cardiac surgery, infection is a leading cause of morbidity and mortality. We created a model to predict risk of major infection in this population. Methods Using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we created a multivariable model in which the primary outcome was major infection (septicemia, mediastinitis, or endocarditis). Candidate independent variables included demographic characteristics, comorbid conditions, preoperative factors, and cardiac surgical procedures. We created a reduced model by backward selection and then created an integer scoring system using a scaling factor with scores corresponding to percent risk of infection. Results Of 30,078 children from 48 centers, 2.8% had major infection (2.6% septicemia, 0.3% mediastinitis, and 0.09% endocarditis). Mortality and postoperative length of stay were greater in those with major infection (mortality: 22.2% vs. 3.0%; length of stay > 21 days: 69.9% vs. 10.7%). Young age, high complexity, previous cardiothoracic operation, preoperative length of stay >1 day, preoperative ventilator support, and presence of a genetic abnormality were associated with major infection after backward selection (p<0.001). Estimated infection risk ranged from <0.1% to 13.3%; the model discrimination was good (c-index 0.79). Conclusions We created a simple bedside tool to identify children at high risk for major infection after cardiac surgery. These patients may be targeted for interventions to reduce the risk of infection and for inclusion in future clinical trials.

Infecciones asociadas a la atención en salud (IAAS) en pacientes pediátricos post-operados de cardiopatías congénitas

“…El retardo en el cierre esternal está asociado con mayor riesgo de infecciones del sitio quirúrgico y con la ocurrencia de infecciones del torrente sanguíneo 29 . Estos antecedentes han permitido, recientemente, el desarrollo de modelos de predicción que tiene como objeto ayudar al médico clínico en la toma de decisiones y evaluación de las medidas de prevención implementadas en los pacientes de mayor riesgo, dentro de los cuales destacan la evaluación de las medidas antimicrobianas y decisión en la antibioprofilaxis de rutina 1,30 . Clavería y cols.…”

Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

“…A study by Barker et al 13 and colleagues concluded that small baby, complex heart disease, open cardiac surgery, preoperative treatment of more than one day, mechanical ventilation use before surgery, and genetic disorder were closely associated with major postsurgical infections such as mediastinitis, sepsis, and endocarditis. 13 Our study analyzed patients who had a high risk of major postsurgical infection (i.e. sepsis) as we included infants with complex cardiac disease and underwent open cardiac surgery.…”

Risk Factors for Death or Heart Transplant for Patients with Right Ventricular Dysfunction After the Norwood Procedure: A Secondary Analysis of the Single Ventricle Reconstruction Trial

“…Barker et al showed that major infections after cardiac surgery in children were associated with a higher chance of death (22 % (95% CI 19 -25 %) vs. 3 % (95% CI 3 -3 %)). They also shown that 70 % (95 % CI 67 -73 %) of the patients staying longer than 21 days in patients that experienced a major infection versus only 11% (95% CI 10 -11 %) of patients without major infections (Barker et al 2010). Holzmann-Pazgal et al similarly showed that surgical site infection was associated with longer ICU stays, longer hospital stays, and was associated with an increased risk of death after adjusting for illness severity (OR 4.9 (95% CI 1.1-22.8), p=0.04) (Holzmann-Pazgal et al 2008).…”

“…Some of the infections are superficial surgical wound infections. However, more rarely, patients will experience major infections, such as septicemia, mediastinitis, and endocarditis (Barker et al 2010). Multiple groups have studied risk factors associated with developing an infection post-pediatric cardiac surgery.…”