Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy.

Creator(s)

Rohit Nallani, Children's Mercy Kansas CityFollow
Brevin J. Miller
Janelle R. Noel-Macdonnell PhD, Children's Mercy HospitalFollow
Meghan Tracy, Children's Mercy HospitalFollow
Jason R. Brown, Children's Mercy HospitalFollow
James E. O'Brien, Children's Mercy Kansas CityFollow
Daniel R. Jensen, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

12-2024

Identifier

DOI: 10.1002/ohn.939

Abstract

OBJECTIVE: Sternal wound infection (SWI) is a rare but potentially life-threatening complication in children following sternotomy. Risk factors include young age, extended preoperative hospitalization, and prolonged ventilatory support. Few studies have explored the impact of pre-existing tracheostomy on SWI in pediatric patients. The purpose of this study is to measure the effect of tracheostomy and other factors on SWI in children undergoing sternotomy.

STUDY DESIGN: Retrospective cohort study of a 12 year period.

SETTING: Tertiary children's hospital.

METHODS: Children with a tracheostomy prior to sternotomy (TPS) were identified and matched by age, height, and weight to children who underwent sternotomy alone. Demographics, medical comorbidities, surgical details, SWI diagnosis and management information, and surgical outcomes were collected.

RESULTS: We identified 60 unique individuals representing 80 sternotomies. The incidence of SWI was 22.5% (n = 9) in children with a tracheostomy and 2.5% (n = 1) in those without. The incidence of SWI was greater in children with a tracheostomy (90% vs 10% in those without, P = .007) and underlying pulmonary disease (90% vs 10% in those without, P = .020). Infections in the TPS group also demonstrated greater frequency of Pseudomonas aeruginosa (n = 3) and polymicrobial growth (n = 2).

CONCLUSION: The risk of developing a SWI in children undergoing sternotomy is significantly greater in those with a tracheostomy and underlying pulmonary disease. Further study is needed to understand other contributing factors and ways to mitigate this risk.

Journal Title

Otolaryngology and head and neck surgery

Volume

171

Issue

6

First Page

1872

Last Page

1878

MeSH Keywords

Humans; Tracheostomy; Retrospective Studies; Surgical Wound Infection; Male; Sternotomy; Female; Child, Preschool; Child; Risk Factors; Incidence; Infant; Adolescent

Keywords

pediatric sternotomy; pediatric tracheotomy; sternal wound infection; surgical outcomes; surgical site infection

Recommended Citation

Nallani R, Miller BJ, Noel-MacDonnell JR, et al. Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy. Otolaryngol Head Neck Surg. 2024;171(6):1872-1878. doi:10.1002/ohn.939