Asymmetric sternotomy and sternal wound complications: assessment using 3-dimensional computed tomography
Joshua Y Jacobson1, Matthew E Doscher, William J Rahal
1From the *Albert Einstein College of Medicine; and †Division of Plastic and Reconstructive Surgery, ‡Department of Surgery, and Department of Vascular and Cardiothoracic Surgery, Montefiore Medical Center, Bronx, NY USA.
Insights
Sternal asymmetry, a difference of 10% or greater in sternal halves, is linked to sternal wound infections after midline sternotomy. Surgeons should assess asymmetry to improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Wound complications following midline sternotomy contribute to significant patient morbidity and mortality.
- While numerous risk factors for sternal wound infections are known, sternal asymmetry has been under-investigated.
Purpose of the Study:
- To evaluate the effectiveness of 3-dimensional computed tomographic (3D CT) scan reconstructions in assessing sternal asymmetry.
- To determine the correlation between sternal asymmetry and the incidence of sternal wound infection.
Main Methods:
- A retrospective review of patients undergoing midline sternotomy and receiving a postoperative CT scan between 2009 and 2010.
- Sternal asymmetry was quantified using 3D CT reconstructions, defined as the percentage difference between the left and right sternal halves.
- Patients with sternal wound infections (cases) were compared to those without complications (controls).
Main Results:
- The study included 26 cases and 32 controls, with similar baseline characteristics.
- Univariate analysis identified sternal asymmetry (≥10%), body mass index, and internal mammary artery harvest as associated with infection.
- Multivariate logistic regression revealed that sternal asymmetry (odds ratio, 3.6; P = 0.03) and diabetes (odds ratio, 3.3; P = 0.0442) were independent predictors of sternal wound infection.
Conclusions:
- The findings suggest a significant association between sternal asymmetry and the development of sternal wound infections.
- Routine assessment of sternal asymmetry using 3D CT scans is recommended for patients with sternal wound infections.
- If asymmetry is 10% or greater, surgeons should consider implementing sternal stabilization measures.
Objective:
Wound complications after midline sternotomy result in significant morbidity and mortality. Despite many known risk factors, the influence of sternal asymmetry has largely been ignored. The purpose of this study was to assess the utility of 3-dimensional computed tomographic scan reconstructions to assess sternal asymmetry and determine its relationship with sternal wound infection.
Methods:
A retrospective chart review was conducted for patients who underwent midline sternotomy and received a postoperative computed tomographic scan between 2009 and 2010. Cases were composed of all patients who had a sternal wound infection after undergoing sternotomy. Controls were randomly selected from patients without poststernotomy wound complications. Sternal asymmetry was defined as the difference between the left and the right sternal halves and was expressed as a percentage of the total sternal volume.
Results:
Twenty-six cases were identified and 32 controls were selected as described earlier. The patients were similar in baseline characteristics and risk factors including age, sex, smoking status, diabetes, chronic obstructive pulmonary disease, preoperative creatinine, and operative time. Univariate factors associated with sternal wound infection include an asymmetry of 10% or greater, body mass index, and internal mammary artery harvest. In a multivariate logistic regression, independent predictors of sternal wound infection included an asymmetry of 10% or greater (odds ratio, 3.6; P = 0.03) and diabetes (odds ratio, 3.3; P = 0.0442).
Conclusions:
Our data suggest an association between asymmetric sternotomy and sternal wound infections. We recommend an assessment of sternal asymmetry to be performed in patients with sternal wound infection and if it is found to be 10% or greater, the surgeon should implement measures that stabilize the sternum.
