Optimal Timing of Multidisciplinary Management of Sternal Wound Complications
Sarah N Chiang1, David Chi1, Pooja S Yesantharao2
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University Medical Center, St Louis, Missouri.
Annals of Thoracic Surgery Short Reports
|January 10, 2025
Summary
Prompt plastic surgery consultation for sternal wound complications significantly reduces reoperations and mortality. Early involvement, within days of complication detection, improves patient outcomes and reduces recurrence rates.
Area of Science:
- Plastic and Reconstructive Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Sternal wound complications following median sternotomy are associated with increased morbidity and mortality.
- Plastic and reconstructive surgery plays a crucial role in managing these complex cases through flap reconstruction.
- The timing of plastic surgery consultation in relation to sternal wound complications is a critical factor influencing patient outcomes.
Purpose of the Study:
- To investigate the impact of the timing of plastic surgery involvement on outcomes in patients with sternal wound complications.
- To identify risk factors associated with adverse outcomes in sternal wound complications.
- To determine if early plastic surgery consultation is associated with improved patient prognosis.
Main Methods:
- Retrospective review of 188 patients with sternal wound complications over a 10-year period.
- Patients were stratified into quartiles based on the time from complication detection to plastic surgery consultation (immediate, early, delayed, late).
- Primary outcomes included postoperative complications, reoperation rates, and 1-year all-cause mortality, analyzed using univariable and multivariable logistic regression.
Main Results:
- Increased time to plastic surgery consultation was significantly associated with higher rates of sternal wound reoperations (P=.026), 1-year mortality (P=.008), hematoma (P=.044), and sternal dehiscence recurrence (P=.019).
- Multivariable analysis confirmed that delayed consultation increased the odds of reoperation (OR, 1.1; P=.041), recurrence (OR, 1.5; P=.018), and mortality (OR, 1.3; P=.037).
- No significant differences in patient demographics, comorbidities, or reconstructive characteristics were observed across the consultation time groups.
Conclusions:
- Early involvement of plastic surgery in managing sternal wounds is significantly linked to reduced mortality, recurrence of sternal dehiscence, and fewer reoperations.
- Prompt plastic surgery consultation is a key component of successful multidisciplinary collaboration for treating complex sternal wound complications.
- These findings underscore the importance of timely surgical intervention for optimizing patient recovery and minimizing adverse events.
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