Rigid sternal fixation improves postoperative recovery
Hitoshi Hirose1, Kentaro Yamane, Benjamin A Youdelman
1Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Rigid sternal fixation in cardiac surgery patients significantly reduces intubation and ICU time. This method aids early recovery in carefully selected, low-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Ridged sternal fixation is increasingly used for sternal closure post-cardiac surgery.
- While known for enhancing sternal stability, its impact on patient recovery remains under-investigated.
Purpose of the Study:
- To evaluate the effect of rigid sternal fixation on patient recovery after cardiac surgery.
- To compare outcomes between rigid sternal fixation and conventional sternal closure methods.
Main Methods:
- Retrospective chart review of patients undergoing CABG and/or valve surgery (2009-2010).
- Comparison of 89 patients with rigid fixation (Group R) versus 133 patients with conventional closure (Group C).
- Multivariate analyses to identify factors influencing sternal closure method and postoperative recovery.
Main Results:
- Group R patients were younger, more male, and had lower EuroSCORE, suggesting selection for lower-risk individuals.
- Rigid fixation was associated with significantly shorter intubation times (13 vs. 39 hours) and ICU stays (58 vs. 99 hours).
- Multivariate analysis identified rigid sternal fixation as a dominant factor in reducing intubation and ICU duration.
Conclusions:
- Rigid sternal fixation systems are predominantly used in younger, low-risk male patients.
- In this selected patient cohort, rigid sternal fixation contributes to earlier postoperative recovery.
Introduction:
During the past five years, ridged sternal fixation has been utilized for sternal closure after cardiac surgery. It is known that this procedure provides better sternal stability; however, its contribution to patient recovery has not been investigated.
Methods:
Retrospective chart review was conducted for patients who underwent CABG and/or valve surgery in our institution between 2009 and 2010. Preoperative, perioperative, and follow-up data of patients with ridgid fixation (group R, n=89) were collected and compared with those patients with conventional sternal closure (group C, n=133). The decision regarding the sternal closure method was based on the surgeon's preferences. Univariate followed by multivariate analyses were performed to evaluate the dominant factor of sternal lock usage and to evaluate postoperative recoveries. The factors included in the analyses were; age, sex, coronary risk factors, urgency of surgery, ejection fraction, coronary anatomy, preoperative stroke, renal function, and preoperative presence of heart failure. All statistical analyses were performed by JMP software.
Results:
Group R was younger (62 ± 9 in group R vs 69 ± 11 in group C, p<0.0001) than group C, more male dominant (61% vs 49%, p=0.0452), had a lower percentage of patients undergoing redo-surgery (2.2% vs 9.0%, p<0.0418), was more likely to be used in isolated coronary artery bypass grafting (71% vs 46%, p=0.0002), more often to be used for large patient (body mass index, BMI greater than 30) (58% vs 37%. P=0.0045), and patients were more likely to have a low EuroSCORE (2.6 ± 2.3 vs 4.4 ± 2.7). Intubation time (13 ± 20 hours vs 39 ± 97 hours, p=0.0030), ICU stay (58 ± 40 hours vs 99 ± 119 hours, p=0.0003), and postoperative length of stay (7.0 ± 3.7 days vs 8.4 ± 4.7 days, p<0.0141) were significantly shorter in group R than group C. Multivariate analyses showed ridged sternal fixation was the most dominant factor affecting intubation time and ICU stay.
Conclusion:
Rigid sternal fixation systems were more frequently applied to low risk young male patients. Among these selected patients, ridgid sternal fixation can contribute to early patient recovery.
