Replacing Sternal Precautions as Part of a Cardiac Enhanced Recovery Program

Sternal precautions postcardiac surgery are variable and can impair the ability to discharge patients directly home. As part of our Enhanced Recovery After Surgery program we implemented, "Keep Your Move in The Tube" (KYMITT), allowing patients to perform previously restricted upper extremity activities. We hypothesized that implementation of KYMITT would facilitate early mobility and discharge directly home for our patients without further complications.

Data from 1640 consecutive adult cardiac surgery patients with a median sternotomy from October 2020 to December 2023 were analyzed. Data were collected regarding outcome measures of interest. No patients were excluded from KYMITT regardless of risk factors for poor wound healing. Data were compared to historical controls undergoing sternotomy cardiac surgery from January 1 to December 31, 2019 (n = 550).

The average age of cardiac surgery patients was 66 years and the majority were male (pre-KYMITT era, 74%; KYMITT era, 72%). A significantly larger portion of KYMITT patients were discharged to home (84% vs 70%, P < .001). There was no difference in the rate of surgical site infections (0.4% vs 0.2%, P = .6), deep sternal wound infections (0.2% vs 0%, P = .25), or sternal dehiscence (0% vs 0.1%, P = 1).

Our data suggest that KYMITT, as an integral part of an Enhanced Recovery After Surgery Program, can facilitate discharging patients directly home without an increase in sternal complications.