Sternum Dehiscence: A Preventable Complication of Median Sternotomy
Emin Can Ata1, Metin Onur Beyaz1
1Department of Cardiovascular Surgery, Medipol Mega University Hospital, Istanbul, Turkey. dr.enata@yahoo.com.
Insights
Enhanced sternal closure techniques significantly reduced sternal dehiscence, mediastinitis, and mortality after cardiothoracic surgery. Implementing these methods improves patient outcomes and lowers hospital costs.
Area of Science:
- Cardiothoracic Surgery
- Surgical Complications
- Wound Closure Techniques
Background:
- Sternal dehiscence is a rare but significant complication following sternotomy.
- It leads to patient dissatisfaction and increased healthcare costs.
- Previous efforts focused on reducing this complication.
Purpose of the Study:
- To summarize techniques for preventing sternal dehiscence after median sternotomy.
- To evaluate the effectiveness of enhanced closure methods compared to standard sternal wire closure.
Main Methods:
- Retrospective study of 2,664 patients undergoing median sternotomy (March 2009 - May 2019).
- Group 1 (n=1,105): Sternum wire only.
- Group 2 (n=1,559): Sternum wire plus preventive closure techniques for high-risk patients (e.g., reinforced sutures, sternal cable, sternal plate, Robiscek technique).
Main Results:
- No sternal dehiscence in Group 2 vs. 2.6% in Group 1 (P=.001).
- Mediastinitis incidence was lower in Group 2 (P=.004).
- Sternum-related mortality was significantly reduced in Group 2 (P=.048).
Conclusions:
- Perioperative risk assessment and enhanced sternal closure techniques effectively prevent sternal dehiscence.
- These enhanced methods also reduce mediastinitis and sternum-related mortality.
- Improved closure strategies enhance patient outcomes and potentially lower healthcare expenditures.
Background:
The incidence of sternal dehiscence following cardiothoracic surgery via sternotomy is rare. It causes serious patient dissatisfaction and leads to higher hospital costs. For years, each clinic has made efforts to reduce this complication. Here, we aimed to summarize our techniques to prevent dehiscence.
Material:
This retrospective study included two groups operated via median sternotomy from March 2009 to May 2019. The first group included 1,105 consecutive patients who only received sternum wire for sternum closure from March 2009 to October 2013. The second group included 1,559 consecutive patients operated from January 2014 to May 2019; preventive closure techniques were performed for predefined high-risk patients in this group. These closure techniques included polyglyconate (Maxon) or simple longitudinal reinforced sutures, sternal cable or sternoband, sternal plate, and Robiscek technique.
Results:
All patients in Group 1, and 63.8% (995/1559) patients in Group 2 received sternal wire only (P < .001). In Group 2, we applied preventive closure techniques to 564 (36.2%) patients. There was no sternal dehiscence in Group 2, whereas 29 (2.6%) patients postoperatively suffered sternal dehiscence in Group 1; this was statistically significant (P = .001, OR:85.5, 95%CI:5.22-1400.4). The overall incidence of mediastinitis was 0.94%. The incidence significantly was lower in Group 2 (P = .004, OR:3.6, 95%CI:1.52-8.82). Sternum-related mortality in Group 2 also was lower (0.54% versus 0.06%, P = .048, OR:8.5, 95% CI: 1.02-70.75).
Conclusion:
Sternal dehiscence can be avoided by careful perioperative risk assessment and enhanced closure techniques. The same special consideration may significantly reduce mediastinitis and sternal-related mortality.
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