Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes
Background: Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by...
Gespeichert in:
| Veröffentlicht in: | World journal for pediatric & congenital heart surgery 2021-10, Vol.12 (5), p.589-596 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 596 |
|---|---|
| container_issue | 5 |
| container_start_page | 589 |
| container_title | World journal for pediatric & congenital heart surgery |
| container_volume | 12 |
| creator | Asfari, Ahmed Clark, Matthew G. Hock, Kristal M. Huskey, Jordan L. Rahman, A. K. M. F. Dabal, Robert J. Borasino, Santiago |
| description | Background:
Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early ( 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC.
Methods:
Retrospective chart review of neonates and infants ( |
| doi_str_mv | 10.1177/21501351211022413 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2578768203</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_21501351211022413</sage_id><sourcerecordid>2578768203</sourcerecordid><originalsourceid>FETCH-LOGICAL-c340t-345dbfac05681378dfba0c09b8ac95a7ffe647e51cd70e92874b3ce2e032812f3</originalsourceid><addsrcrecordid>eNp9kM1Kw0AUhQdRbKl9ADcySzep85PJJMtSqhYKCmpxFyaTG0lJMnVuInTnQ_iEPokprd0I3s09XM45XD5CLjmbcK71jeCKcam44JwJEXJ5Qoa7W8Bl9Hp61IoPyBhxzfoJIynD8JwMZKgSLRgbktXc-GpLV-CxQ7o0LdCnFnxjKjqrHHYeaNnQRVOYpsXvz69H8KXbgDdt-QF0iuhs2WvXIDVNTh-61roa8IKcFaZCGB_2iLzczp9n98Hy4W4xmy4DK0PWBv0feVYYy1QUc6njvMgMsyzJYmMTZXRRQBRqUNzmmkEiYh1m0oIAJkXMRSFH5Hrfu_HuvQNs07pEC1VlGnAdpkLpWEexYLK38r3VeofooUg3vqyN36acpTui6R-ifebqUN9lNeTHxC-_3jDZG9C8Qbp23Y4c_tP4A0JJfpI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2578768203</pqid></control><display><type>article</type><title>Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes</title><source>Access via SAGE</source><source>MEDLINE</source><creator>Asfari, Ahmed ; Clark, Matthew G. ; Hock, Kristal M. ; Huskey, Jordan L. ; Rahman, A. K. M. F. ; Dabal, Robert J. ; Borasino, Santiago</creator><creatorcontrib>Asfari, Ahmed ; Clark, Matthew G. ; Hock, Kristal M. ; Huskey, Jordan L. ; Rahman, A. K. M. F. ; Dabal, Robert J. ; Borasino, Santiago</creatorcontrib><description><![CDATA[Background:
Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC (> 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC.
Methods:
Retrospective chart review of neonates and infants (<one-year-old) with DSC after heart surgery from December 2012 to December 2018. Patients requiring extracorporeal membrane oxygenation were excluded.
Results:
A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively (P < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; P< .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; P < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; P < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; P = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; P = .02).
Conclusions:
Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.]]></description><identifier>ISSN: 2150-1351</identifier><identifier>EISSN: 2150-136X</identifier><identifier>DOI: 10.1177/21501351211022413</identifier><identifier>PMID: 34597200</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Cardiac Surgical Procedures - adverse effects ; Humans ; Infant ; Infant, Newborn ; Length of Stay ; Retrospective Studies ; Sternum ; Wound Closure Techniques</subject><ispartof>World journal for pediatric & congenital heart surgery, 2021-10, Vol.12 (5), p.589-596</ispartof><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c340t-345dbfac05681378dfba0c09b8ac95a7ffe647e51cd70e92874b3ce2e032812f3</citedby><cites>FETCH-LOGICAL-c340t-345dbfac05681378dfba0c09b8ac95a7ffe647e51cd70e92874b3ce2e032812f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/21501351211022413$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/21501351211022413$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34597200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Asfari, Ahmed</creatorcontrib><creatorcontrib>Clark, Matthew G.</creatorcontrib><creatorcontrib>Hock, Kristal M.</creatorcontrib><creatorcontrib>Huskey, Jordan L.</creatorcontrib><creatorcontrib>Rahman, A. K. M. F.</creatorcontrib><creatorcontrib>Dabal, Robert J.</creatorcontrib><creatorcontrib>Borasino, Santiago</creatorcontrib><title>Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes</title><title>World journal for pediatric & congenital heart surgery</title><addtitle>World J Pediatr Congenit Heart Surg</addtitle><description><![CDATA[Background:
Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC (> 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC.
Methods:
Retrospective chart review of neonates and infants (<one-year-old) with DSC after heart surgery from December 2012 to December 2018. Patients requiring extracorporeal membrane oxygenation were excluded.
Results:
A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively (P < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; P< .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; P < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; P < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; P = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; P = .02).
Conclusions:
Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.]]></description><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Length of Stay</subject><subject>Retrospective Studies</subject><subject>Sternum</subject><subject>Wound Closure Techniques</subject><issn>2150-1351</issn><issn>2150-136X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1Kw0AUhQdRbKl9ADcySzep85PJJMtSqhYKCmpxFyaTG0lJMnVuInTnQ_iEPokprd0I3s09XM45XD5CLjmbcK71jeCKcam44JwJEXJ5Qoa7W8Bl9Hp61IoPyBhxzfoJIynD8JwMZKgSLRgbktXc-GpLV-CxQ7o0LdCnFnxjKjqrHHYeaNnQRVOYpsXvz69H8KXbgDdt-QF0iuhs2WvXIDVNTh-61roa8IKcFaZCGB_2iLzczp9n98Hy4W4xmy4DK0PWBv0feVYYy1QUc6njvMgMsyzJYmMTZXRRQBRqUNzmmkEiYh1m0oIAJkXMRSFH5Hrfu_HuvQNs07pEC1VlGnAdpkLpWEexYLK38r3VeofooUg3vqyN36acpTui6R-ifebqUN9lNeTHxC-_3jDZG9C8Qbp23Y4c_tP4A0JJfpI</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Asfari, Ahmed</creator><creator>Clark, Matthew G.</creator><creator>Hock, Kristal M.</creator><creator>Huskey, Jordan L.</creator><creator>Rahman, A. K. M. F.</creator><creator>Dabal, Robert J.</creator><creator>Borasino, Santiago</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20211001</creationdate><title>Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes</title><author>Asfari, Ahmed ; Clark, Matthew G. ; Hock, Kristal M. ; Huskey, Jordan L. ; Rahman, A. K. M. F. ; Dabal, Robert J. ; Borasino, Santiago</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-345dbfac05681378dfba0c09b8ac95a7ffe647e51cd70e92874b3ce2e032812f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Length of Stay</topic><topic>Retrospective Studies</topic><topic>Sternum</topic><topic>Wound Closure Techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Asfari, Ahmed</creatorcontrib><creatorcontrib>Clark, Matthew G.</creatorcontrib><creatorcontrib>Hock, Kristal M.</creatorcontrib><creatorcontrib>Huskey, Jordan L.</creatorcontrib><creatorcontrib>Rahman, A. K. M. F.</creatorcontrib><creatorcontrib>Dabal, Robert J.</creatorcontrib><creatorcontrib>Borasino, Santiago</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World journal for pediatric & congenital heart surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Asfari, Ahmed</au><au>Clark, Matthew G.</au><au>Hock, Kristal M.</au><au>Huskey, Jordan L.</au><au>Rahman, A. K. M. F.</au><au>Dabal, Robert J.</au><au>Borasino, Santiago</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes</atitle><jtitle>World journal for pediatric & congenital heart surgery</jtitle><addtitle>World J Pediatr Congenit Heart Surg</addtitle><date>2021-10-01</date><risdate>2021</risdate><volume>12</volume><issue>5</issue><spage>589</spage><epage>596</epage><pages>589-596</pages><issn>2150-1351</issn><eissn>2150-136X</eissn><abstract><![CDATA[Background:
Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC (> 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC.
Methods:
Retrospective chart review of neonates and infants (<one-year-old) with DSC after heart surgery from December 2012 to December 2018. Patients requiring extracorporeal membrane oxygenation were excluded.
Results:
A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively (P < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; P< .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; P < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; P < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; P = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; P = .02).
Conclusions:
Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.]]></abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>34597200</pmid><doi>10.1177/21501351211022413</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2150-1351 |
| ispartof | World journal for pediatric & congenital heart surgery, 2021-10, Vol.12 (5), p.589-596 |
| issn | 2150-1351 2150-136X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2578768203 |
| source | Access via SAGE; MEDLINE |
| subjects | Cardiac Surgical Procedures - adverse effects Humans Infant Infant, Newborn Length of Stay Retrospective Studies Sternum Wound Closure Techniques |
| title | Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T19%3A19%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20Versus%20Late%20Sternal%20Closure%20in%20Infants%E2%80%94Perioperative%20Associations%20and%20Outcomes&rft.jtitle=World%20journal%20for%20pediatric%20&%20congenital%20heart%20surgery&rft.au=Asfari,%20Ahmed&rft.date=2021-10-01&rft.volume=12&rft.issue=5&rft.spage=589&rft.epage=596&rft.pages=589-596&rft.issn=2150-1351&rft.eissn=2150-136X&rft_id=info:doi/10.1177/21501351211022413&rft_dat=%3Cproquest_cross%3E2578768203%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2578768203&rft_id=info:pmid/34597200&rft_sage_id=10.1177_21501351211022413&rfr_iscdi=true |