Rigid Sternal Fixation and Enhanced Recovery for Opioid-Free Analgesia After Cardiac Surgery.

Area of Science:

• Cardiovascular Surgery
• Surgical Outcomes
• Pain Management

Background:

• Median sternotomy is a common surgical approach.
• Postoperative pain and opioid use are significant concerns following sternotomy.
• Optimizing recovery protocols and fixation methods is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the independent and combined effects of rigid-plate fixation (RPF) and enhanced recovery protocols (ERP) on outcomes after median sternotomy.
• To assess the impact on postoperative pain, opioid consumption, and patient discharge status.
• To understand the sequential adoption's influence on clinical practice.

Main Methods:

• Single-center, retrospective case-cohort study design.
• Comparison of three patient groups: controls (pre-RPF/ERP), RPF-only, and RPF+ERP (2020/2022).
• Inclusion of 608 median sternotomy patients with detailed outcome data collection.

Main Results:

• Median in-hospital opioid use decreased from 172.5 MMEs (controls) to 0 MMEs (RPF+ERP-2022).
• Direct-to-home discharge rates improved significantly: 66.2% (controls) to 93.5% (RPF+ERP-2022).
• Prescribed discharge opioids reduced from 600 MMEs (controls) to 0 MMEs (RPF+ERP cohorts), without increased readmissions.

Conclusions:

• Systematic implementation of RPF and ERP led to substantial reductions in opioid use.
• The combined approach significantly improved patient discharge outcomes.
• These findings demonstrate a clinically meaningful benefit in a real-world setting.