Surgical site infections after pediatric open airway reconstruction—A National Surgical Quality Improvement Program‐Pediatric analysis

OBJECTIVES: To determine the rate of surgical site infections (SSI) after pediatric open airway reconstruction using a nationwide database. STUDY DESIGN: Cross‐sectional study of the American College of Surgeons National Surgical Quality Improvement Program‐Pediatric (ACS NSQIP‐P) Database. METHODS: The ACS NSQIP‐P was queried for open airway surgeries between 2013 and 2019 determining postoperative SSI and wound dehiscence with a random sample of non‐airway cases serving as a control group. RESULTS: A total of 637 laryngotracheoplasties (LTP), 411 tracheal resections (TR) and 2100 control procedures were included. LTP and TR were both performed on younger children with more comorbidities than control surgeries (p < .05). Postoperative wound complications occurred more often after airway reconstructions than non‐airway cases (6.4% vs. 2.9%, p < .001). Compared to non‐airway procedures, LTP (OR: 2.42, 95% CI: 1.62–3.61) and TR (OR: 2.07, 95% CI: 1.28–3.66) developed increased SSI. Multiple logistic regression identified dirty or infected wounds (OR: 4.61, p < .001, 95% CI: 2.35–9.03) and American Society of Anesthesiologists (ASA) Class IV (OR: 3.19, p = .02, 95% CI: 1.12–8.39) as the strongest predictors of SSI after airway reconstruction. CONCLUSIONS: SSI after pediatric airway reconstruction occur in 6% of cases and are increased in infected wounds and ASA Class IV surgeries. Recognizing common factors for these complications provide reliable benchmarking to design surgical quality improvement initiatives. LEVEL OF EVIDENCE: 4.