Related Experiment Video
Updated: Oct 18, 2025
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Early Versus Late Sternal Closure in Infants-Perioperative Associations and Outcomes
Ahmed Asfari1, Matthew G Clark1, Kristal M Hock1
1Department of Pediatric Cardiac Critical Care Medicine, University of Alabama at Birmingham, AL, USA.
Insights
Delayed sternal closure (DSC) in neonates and infants undergoing heart surgery did not impact mortality but prolonged intensive care and hospital stays. Early DSC (<48 hours) is associated with better resource utilization compared to late DSC (>48 hours).
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery Outcomes
- Neonatal and Infant Critical Care
Background:
- Delayed sternal closure (DSC) is utilized in pediatric cardiac surgery patients experiencing bleeding, edema, or arrhythmias post-cardiopulmonary bypass.
- The optimal timing for DSC is influenced by various clinical and laboratory factors, necessitating further investigation.
Purpose of the Study:
- To compare outcomes between early (<48 hours) and late (>=48 hours) DSC in neonates and infants following heart surgery.
- To identify clinical and laboratory variables associated with the timing of DSC in this pediatric population.
Main Methods:
- A retrospective chart review was conducted on neonates and infants (<1 year old) who underwent DSC after heart surgery between December 2012 and December 2018.
- Patients requiring extracorporeal membrane oxygenation (ECMO) were excluded from the analysis.
Main Results:
- Of 121 patients, 34% required late DSC. While overall survival was 75%, late DSC patients had significantly longer intensive care unit (24.3 vs 36.8 days) and hospital stays (2-fold increase).
- Late DSC was associated with higher intraoperative and postoperative lactate levels and increased vasoactive inotrope scores at 36 hours.
- No significant difference in mortality rates was observed between early and late DSC groups.
Conclusions:
- While not affecting mortality, late DSC in neonates and infants is linked to prolonged resource utilization.
- Further research is warranted to identify specific clinical and laboratory markers to guide optimal DSC timing decisions.
Background:
Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC (> 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC.
Methods:
Retrospective chart review of neonates and infants (
Results:
A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively (P < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; P< .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; P < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; P < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; P = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; P = .02).
Conclusions:
Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.
More Related Videos
15:11Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
Published on: January 5, 2015
09:00Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
