Risk Factors for Mediastinitis Following Median Sternotomy in Children

Lautenbach, Ebbing; Bilker, Warren B.; Matro, Jennifer M.; Bell, Louis M.; Dominguez, Troy E.; Gaynor, J. William; Shah, Samir S.

doi:10.1097/inf.0b013e31806166bb

Cited by 32 publications

(24 citation statements)

References 33 publications

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“…In one of the largest series documenting the risk factors for developing postoperative mediastinitis in children, Kagen et al found that only the presence of a genetic syndrome, an American Society of Anesthesiologists score of >3, and the presence of intracardiac pacing wires for >3 days were statistically significant. [15] None of the children in our series developed mediastinitis, and in none were mediastinal drains left in situ.…”

Section: Resultsmentioning

confidence: 99%

The versatility of median sternotomy in general paediatric surgery

et al. 2013

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Background. While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity. Methods. We conducted a retrospective chart review of all children undergoing MS for non-cardiac indications between January 2007 and September 2012 and describe the pathology, number of ventilated days, duration of intensive care unit stay and analgesic requirements. Results. Our experience over the past 6 years includes 14 children, aged between 8 months and 13 years. Indications for surgery included penetrating mediastinal trauma (1), anterior and posterior mediastinal masses (4), acquired tracheo-oesophageal fistulas secondary to button battery impaction (2), bronchial foreign bodies (2) and bilateral pulmonary metastases secondary to malignancy (5). The range of postoperative ventilation required was 0 -34 days (median 1 day) and the range of duration of stay in the paediatric intensive care unit 1 -39 days (median 4 days). Postoperative analgesia was provided with intravenous or oral paracetamol with or without the addition of morphine. All the children tolerated the procedure well with no sternotomy-related complications on follow-up. Conclusion. This review highlights the variety of conditions in which MS provides unrivalled access to the mediastinum and how well the procedure is tolerated by the paediatric patient, and emphasises the importance of sternotomy being within the armamentarium of access techniques of the general paediatric surgeon.

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Section: Resultsmentioning

confidence: 99%

The versatility of median sternotomy in general paediatric surgery

et al. 2013

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“…Some of the preoperative factors that are generally believed to affect SSIs include newborns aged <1 month, infants aged <1 year, duration of preoperative hospitalization ≥48 h, and genetic syndromes. 8,12,14,15) In terms of the preoperative attributes of the patients in this study, patients in Group R were younger than those in Group E, with significantly lower height, weight and body surface area (Table 1). Despite this, the occurrence of SSIs and mediastinitis was reduced in Group R. This indicates that the efficacy of our SSI prevention measures outweighed the disadvantage of small body size.…”

Section: Discussionmentioning

confidence: 99%

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Katayanagi

2015

ATCS

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Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA)is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

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“…26 Different risk factors that may predispose children for mediastinitis, such as wound contamination at the time of surgical procedure, prolonged surgical times, younger age, use of deep hypothermia, and a higher American Society of Anesthesiologists score, have been reported. 27 Kagan and colleagues 27 looked at the risk factors for mediastinitis after median sternotomy in children. They demonstrated that an American Society of Anesthesiologists score of 4 or greater, duration of epicardial pacing wires greater than 3 days, and a known or a possible genetic syndrome or chromosomal abnormality were risk factors that were associated with the development of mediastinitis.…”

Section: Complicationsmentioning

confidence: 99%