title: Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease.
abstract: BACKGROUND
  We sought to determine whether longer duration before delayed sternal closure (DSC) increases the risk of mortality, postoperative infection, or wound dehiscence.
  
  
  METHODS
  A retrospective review was performed of 154 patients who underwent DSC between January 1999 and April 2009. Median body weight and age at operation were 3.6 kg (1.5 to 80 kg) and 25 days (2 days to 20 years), respectively. Palliative procedures were performed in 58 patients (58/154, 37.7%). Sternal wound problems were categorized according to the consensus-based definitions. Multivariate analysis was conducted encompassing various preoperative and intraoperative variables to identify risk factors for adverse surgical outcomes. The mean comprehensive Aristotle score (CAS) was 13.2±3.1.
  
  
  RESULTS
  There were 28 hospital mortalities (28/154, 18.2%). Excluding patients who died before sternal closure (4/154, 2.6%), the median duration of sternal opening was 3.5 days (1 to 182 days). Postoperative infection (sternal wound infection or systemic infection) and sterile wound dehiscence (SWD) occurred in 17 and 14 patients, respectively. Multivariate analysis revealed that duration of ventilatory support increased the risk of mortality (p=0.004), and postoperative infection/SWD (p=0.001). CAS also correlated with postoperative infection/SWD (p=0.026). Duration of sternal opening however was associated with none of the outcome variables.
  
  
  CONCLUSIONS
  Long ventilatory support and complexity of the cardiac anomaly increase the risk of adverse outcomes after procedures to repair congenital cardiac anomalies . After adjusting these variables, longer duration before DSC does not seem to be a risk factor for surgical mortality, postoperative infection, or wound dehiscence.
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Hong Ju
authors.initials: HJ
authors.lastname: Shin
authors.forename: Won Kyoung
authors.initials: WK
authors.lastname: Jhang
authors.forename: Jeong-Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Yun
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D010166:Palliative Care; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D056346:Sternotomy / Q000379:methods* / Q000401:mortality; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000401:mortality; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality; D013536:Suture Techniques; D015300:Ventilator Weaning; D058106:Wound Closure Techniques / Q000401:mortality; D055815:Young Adult