Use of longitudinal rigid sternal fixation in prevention and treatment of wound complications among high‐risk patients after cardiac surgery

Madjarov, Jeko M.; Katz, Michael G.; Fazal, Shahood; Kumar, Arvind; Madzharov, Svetozar; Handa, Armaan; Madjarova, Sophia; Robicsek, Francis

doi:10.1111/jocs.15687

Cited by 8 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In most institutions like ours, single stainless-steel wires are used for sternum closure where the sutures are passed around the sternal body and through the manubrium or sternum body. The optimal number of single wires is not known [ 18 , 19 ], but Friberg et al demonstrated that the use of fewer than six wires rather than seven or more increased the rate of sternal wound infection from 0.4 to 4.2% [ 20 ]. Cadaveric studies have indicated increased stability of the sternum by using double wires, especially in obese patients, and a more recent review and meta-analysis illustrated the same [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Non-infectious sternal dehiscence after coronary artery bypass surgery

Silverborn

Heitmann

Sveinsdottir

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

Introduction Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients. Materials and methods A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.

show abstract

Section: Discussionmentioning

confidence: 99%

Non-infectious sternal dehiscence after coronary artery bypass surgery

Silverborn

Heitmann

Sveinsdottir

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…14 Highrisk patients are likely to experience postsurgical complications such as mediastinitis, sternum healed with deformity, sternal nonunion or sternal dehiscence. [15][16][17] Mediastinitis was one of the most lethal complications after cardiac surgery, and an overall mortality between 10% and 47% has been reported, which need extensive surgical debridement and long-term reconstruction. 18 These serious complications highlight the importance of a proper sternal closure device in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…The initial hospitalization costs, examination costs, treatment costs, total healthcare costs at 6 months and 12 months for all high-risk sternotomy patients is summarized in table 4. NRSP group had greater costs associated with their hospitalization compared with WC group($22,459 [19,469] vs $20,067 [17,,610], p¡0.001), driven primarily by the initial costs of NRSP. There was a non-significant trend in the costs of pharmacy, ICU, laboratory and imaging with or without NRSP(p¿0.05).…”

Section: Healthcare Costmentioning

confidence: 97%

Application of new rigid sternal plates and prediction of sternal dehiscence in high-risk patients

Wang

Hao

2022

Preprint

View full text Add to dashboard Cite

Background: Sternal dehiscence is a serious complication of cardiac surgery that has been a clinically intractable problem. The study aimed to explore the advantages of new rigid sternal plates (NRSP) compared with wire cerclage (WC) in the cardiac surgery of high- risk patients with sternal dehiscence and summarize the application experience. Methods: A retrospective analysis was performed on high-risk patients for sternal dehiscence who underwent cardiac surgery operation in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021. All cases were identified and divided into WC (n=276) and NRSP (n=291). Risk factors for sternal complications, postoperative outcomes and cost associated with surgery and subsequent treatment were analyzed. Results: There was no significant difference in demographics and preoperative comorbidities compared to patients with WC(p＞0.05), those with NRSP had longer sternal closure time(p＜0.001). However, there are shorter hospital length of stay(p＜0.001), less postoperative drainage volume of 24h (p＜0.001), and lower total costs at 6 months(p=0.043) and 12 months(p＜0.001) in NRSP patients. After multivariate logistic regression analysis, the remaining five independent risk factors for the development of sternal dehiscence were used to compose the nomogram. The area under the receiver operating characteristic curve (AUC) of the model was 0.865 (95% confidence interval [CI], 0.802–0.927), and the calibration curve was good by the Hosmer–Lemeshow test. Conclusions: NRSP can enhance the stability of sternal fixation in high-risk patients after cardiac surgery and reduce the risk of sternal complications. Moreover, the nomogram comprised of age, body mass index (BMI)＞30kg/m , diabetes mellitus(DM), chronic obstructive pulmonary disease (COPD) and sternal closure method may predict the risk of sternal dehiscence.

show abstract

“…Unfortunately, patients undergoing open thoracic/cardiac surgery had the highest rate of prolonged opioid use compared with other surgical cohorts ( 12 ). Others and we believe that improving the usual surgical techniques of the chest closing will minimize the risk of postoperative neuropathic pain ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability

et al. 2023

Self Cite

View full text Add to dashboard Cite

IntroductionThe pathogenesis of chronic chest pain after cardiac surgery has not been determinate. If left untreated, postoperative sternal pain reduces the quality of life and patient satisfaction with cardiac surgery. The purpose of the study was to examine the effect of chest inflammation on postoperative pain, risk factors for chronic pain after cardiac surgery and to explore how chest reconstruction was associated with the intensity of pain.MethodsThe authors performed a study of acute and chronic thoracic pain after cardiac surgery in patients with and without sternal infection and compared different techniques for chest reconstruction. 42 high-risk patients for the development of mediastinitis were included. Patients with mediastinitis received chest reconstruction (group 1). Their demographics and risk factors were matched with no-infection patients with chest reconstruction (group 2) and subjects who underwent conventional sternal closure (group 3). Chronic pain was assessed by the numeric rating scale after surgery.ResultsThe assessment of the incidence and intensity of chest pain at 3 months post-surgery demonstrated that 14 out of 42 patients across all groups still experienced chronic pain. Specifically, in group 1 with sternal infection five patients had mild pain, while one patient experienced mild pain in group 2, and eight patients in group 3. Also, follow-up results indicated that the highest pain score was in group 3. While baseline levels of cytokines were increased among patients with sternal infection, at discharge only the level of interleukin 6 remained high compared to no infection groups. Compared to conventional closure, after chest reconstruction, we found better healing scores at 3-month follow-up and a higher percentage of patients with the complete sternal union.ConclusionsOverall, 14 out of 42 patients have chronic pain after cardiac surgery. The intensity of the pain in mediastinitis patients significantly decreased at 3 months follow-up after chest reconstruction. Thus, post-surgery mediastinitis is not a determining factor for development the chronic chest pain. There is no correlation between cytokines levels and pain score except interleukin 6 which remains elevated for a long time after treatment. Correlation between sternal healing score and chronic chest pain was demonstrated.

show abstract

Use of longitudinal rigid sternal fixation in prevention and treatment of wound complications among high‐risk patients after cardiac surgery

Cited by 8 publications

References 17 publications

Non-infectious sternal dehiscence after coronary artery bypass surgery

Non-infectious sternal dehiscence after coronary artery bypass surgery

Application of new rigid sternal plates and prediction of sternal dehiscence in high-risk patients

Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability

Contact Info

Product

Resources

About