Functional outcomes of patients with sternectomy after cardiothoracic surgery: a case series

One potential complication after cardiothoracic surgery involves mediastinitis, which may lead to a sternectomy. A sternectomy involves partial or total debridement of the sternum to remove infected bone. Little evidence regarding functional outcomes following sternectomy exists in literature. The purpose of this case series is to report the demographics of 6 patients admitted to a long term acute care hospital (LTACH) treated for sternectomy after open heart surgery, along with presenting length of stay (LOS) data, analyzing functional outcomes, and describing the physical therapy (PT) interventions used with these patients to obtain the reported functional outcomes.

Medical charts were reviewed retrospectively. Information in four main areas were extrapolated from the chart and further analyzed: patient demographics, length of hospital stay (acute care and LTACH), admission and discharge FIM scores, and information about the PT interventions (both numerical and descriptive).

Patients included 5 males and 1 female with an age range of 65-78 years old (mean 70 years old, SD 4.8 years). Patients had a total mean acute care LOS of 26.33 (12.26) days and total mean LTACH LOS of 27.67 (11.74) days. Median total FIM score at admission was 80.00 [range 58.00-94.00], while the median total FIM score at discharge increased significantly to 106.50 [range 86.00-116.00] (p = 0.031). Total mean FIM score change during LTACH stay (efficiency) was 25.17 (3.25), and FIM score change per day (efficacy) was 1.23 (0.46). Median motor score had a significant increase from admission to discharge (p = 0.031). Median cognitive score did not significantly change from admission to discharge (p = 0.125). PT interventions used with this patient population were presented and described, with a mean number of PT sessions in LTACH of 27.33 (15.38) (range = 10-46).

Although patients required an increased acute care LOS and an additional stay on LTACH, all 6 patients were discharged home following a course of multi-disciplinary inpatient rehabilitation on a LTACH unit. Patients are able to make significant functional gains during rehabilitation following sternectomy, as evidenced by increases in FIM score.