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Background: 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 preexisting 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.

Methods: A retrospective study was performed of children undergoing sternotomy over a 12-year period at a tertiary children’s hospital. Children with a tracheostomy prior to sternotomy (TPS) were identified and matched by age, height, and weight to children who underwent sternotomy alone (SA). 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 sternal wound infection 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=0.007) and underlying pulmonary disease (90% vs. 10% in those without, P=0.020). Infections in the TPS group also demonstrated greater frequency of Pseudomonas aeruginosa (n=3) and polymicrobial growth (n=2).

Conclusions: 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.

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Impact of tracheostomy status on sternal wound infections in children following median sternotomy