Rigid Primary Sternal Fixation Reduces Sternal Complications Among Patients at Risk.
Adult
Aged
Bone Plates
Bone Wires
Cardiac Surgical Procedures
/ adverse effects
Cardiopulmonary Bypass
Cohort Studies
Databases, Factual
Female
Humans
Internal Fixators
/ statistics & numerical data
Logistic Models
Male
Middle Aged
Prognosis
Propensity Score
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Sternotomy
/ adverse effects
Surgical Wound Dehiscence
/ prevention & control
Surgical Wound Infection
/ prevention & control
Treatment Outcome
Wound Closure Techniques
/ instrumentation
Wound Healing
/ physiology
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
11
07
2018
revised:
09
03
2019
accepted:
12
03
2019
pubmed:
19
4
2019
medline:
15
1
2020
entrez:
19
4
2019
Statut:
ppublish
Résumé
The optimal sternal closure technique in patients at elevated risk after cardiac surgery has not been elucidated. Between January 2006 and July 2015, 15,048 consecutive adult patients underwent cardiac surgery via median sternotomy using cardiopulmonary bypass. Rigid sternal fixation using 3 separate techniques (peristernal polyether ether-ketone banding, titanium plating, and stainless steel multibraided cables with cannulated screws) was used in 1111 patients (group A), whereas conventional peristernal/transsternal wiring was used in 13,937 patients (group B). Predictors of deep sternal wound infection or dehiscence were evaluated, and propensity score analysis was used to create 2 matched groups; 1050 group A patients (94.5%) were matched to group B patients. Mean time to presentation was 31 ± 70.3 days (median, 19) after surgery. There was a decreased incidence of deep sternal wound infection or dehiscence among propensity score-matched group A compared with group B patients (1.9% vs 2.7%, P = .13), although it was not statistically significant. On multivariate analysis, group A was associated with a 33% relative risk reduction of deep sternal wound infection or dehiscence (odds ratio, 0.67; 95% confidence interval, 0.48-0.94; P = .02); this was entirely due to a protective effect associated with polyether ether-ketone banding (odds ratio, 0.4; 95% confidence interval, 0.3-0.7; P = .0002). In the subgroup of bilateral internal mammary artery grafting patients (n = 886), there was a strong protective trend associated with preventative sternal fixation, although it was not statistically significant (odds ratio, 0.3; 95% confidence interval, 0.09-1.09; P = .06). Primary sternal fixation in patients at risk of sternal complications is associated with decreased sternal infection and/or dehiscence. Primary fixation may expand the use of bilateral internal mammary artery grafting to patient populations at increased risk for sternal complications.
Sections du résumé
BACKGROUND
The optimal sternal closure technique in patients at elevated risk after cardiac surgery has not been elucidated.
METHODS
Between January 2006 and July 2015, 15,048 consecutive adult patients underwent cardiac surgery via median sternotomy using cardiopulmonary bypass. Rigid sternal fixation using 3 separate techniques (peristernal polyether ether-ketone banding, titanium plating, and stainless steel multibraided cables with cannulated screws) was used in 1111 patients (group A), whereas conventional peristernal/transsternal wiring was used in 13,937 patients (group B). Predictors of deep sternal wound infection or dehiscence were evaluated, and propensity score analysis was used to create 2 matched groups; 1050 group A patients (94.5%) were matched to group B patients.
RESULTS
Mean time to presentation was 31 ± 70.3 days (median, 19) after surgery. There was a decreased incidence of deep sternal wound infection or dehiscence among propensity score-matched group A compared with group B patients (1.9% vs 2.7%, P = .13), although it was not statistically significant. On multivariate analysis, group A was associated with a 33% relative risk reduction of deep sternal wound infection or dehiscence (odds ratio, 0.67; 95% confidence interval, 0.48-0.94; P = .02); this was entirely due to a protective effect associated with polyether ether-ketone banding (odds ratio, 0.4; 95% confidence interval, 0.3-0.7; P = .0002). In the subgroup of bilateral internal mammary artery grafting patients (n = 886), there was a strong protective trend associated with preventative sternal fixation, although it was not statistically significant (odds ratio, 0.3; 95% confidence interval, 0.09-1.09; P = .06).
CONCLUSIONS
Primary sternal fixation in patients at risk of sternal complications is associated with decreased sternal infection and/or dehiscence. Primary fixation may expand the use of bilateral internal mammary artery grafting to patient populations at increased risk for sternal complications.
Identifiants
pubmed: 30998904
pii: S0003-4975(19)30551-X
doi: 10.1016/j.athoracsur.2019.03.046
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
737-743Informations de copyright
Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.