Comorbidity Trends in Patients Requiring Sternectomy and Reconstruction: Updated Data Analysis From 2005 to 2020

Area of Science:

• Plastic Surgery
• Thoracic Surgery
• Surgical Outcomes

Background:

• Median sternectomy is a surgical procedure with evolving patient demographics.
• The patient population undergoing sternectomy has become increasingly complex with higher comorbidity burdens.
• Previous studies have analyzed comorbidity trends, but recent data is needed.

Purpose of the Study:

• To analyze trends in comorbidities and outcomes for patients undergoing median sternectomy and flap reconstruction.
• To identify factors associated with mortality in this complex patient population.
• To compare current trends with historical data.

Main Methods:

• Retrospective review of 105 patients who underwent median sternectomy and flap reconstruction between 2005 and 2020.
• Analysis of comorbidities, reconstruction methods, laboratory values, and complications.
• Univariate analysis to identify associations with mortality.

Main Results:

• The most common comorbidities were hypertension (58%), diabetes (27%), and renal insufficiency (23%).
• Omentum (45%) and pectoralis major flaps (34%) were the most frequent reconstruction methods.
• Thirty-day mortality was 10%, with significant associations between mortality and sex, renal insufficiency, surgical site complications, wound dehiscence, and flap failure.

Conclusions:

• Despite improved medical management leading to a decreased mortality rate (10%), renal insufficiency remains associated with mortality after median sternectomy.
• The increased use of omentum flaps suggests adaptation to a more complex patient population.
• Wound dehiscence and flap failure are associated with mortality, highlighting the challenges in reconstructing sternectomies in high-comorbidity patients.