Management of Sternal Precautions Following Median Sternotomy by Physical Therapists in Australia: A Web-Based Survey

Abstract

Background Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions. Objective The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital. Design A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study. Methods The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate. Results The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included “workplace practices/protocols” (n=27) and “clinical experience” (n=22). Limitations The study may be limited by response bias. Conclusions Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay.

The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial

“…Whilst ‘standard care’ is not consistent in the literature cited previously [8, 13, 14, 24, 25], centres worldwide limit the use of the upper limbs for a minimum of 6 weeks [8, 13, 14, 24, 25]. The protocol we will apply is consistent across both institutions in this study.…”

“…These precautions are used worldwide, although they are applied for variable periods of time (4 weeks to 3 months) post-operatively [8, 13, 14]. The evidence to support sternal precautions is limited to cadaver and replica bone model studies [15, 16].…”

“…Upper limb and trunk exercises are encouraged as part of post-operative care to promote recovery and return of function [8, 13, 14, 18]. Sturgess et al found that exercises of the trunk and upper limb significantly reduced sternal pain during the first 6 weeks post-operatively [20].…”

Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach

“…However, there were numerous concerns about sternal precautions needed after the sternotomy to prevent sternal instability especially regarding weight lifting restrictions. There was no exact weight specified although data from a web-based survey in Australia by Tuyl et al reported the common use of a weight restriction of 2 to 5 kg [5]. This may interfere with a normal maternal-child relationship and bonding because the mother would need to avoid holding her child due to pain and breast feeding may be difficult.…”

“…The standard operative technique for dealing with a cardiac myxoma is the median sternotomy approach which allows the removal of the mass under cardiopulmonary bypass [1]. However, the sternal precautions needing to be applied after the sternotomy in order to avoid sternal dehiscence include using wound support, lifting restrictions, mobility aid restrictions, and driving restrictions [5]. These restriction protocols, especially weight lifting restrictions, may lead to poor child-mother bonding especially during the first 3 to 6 months after surgery and may interfere with breast feeding.…”