Risk factors associated with sternal complication after lung transplantation with transverse sternotomy

Area of Science:

• Thoracic surgery
• Transplant medicine
• Wound healing research

Background:

• Sternal wound dehiscence and infection are significant complications following lung transplantation, impacting patient outcomes.
• These complications are associated with increased mortality, prolonged hospitalization, and impaired graft function.
• Limited contemporary data exists on patient- and procedure-related risk factors for sternal complications in lung transplant recipients.

Purpose of the Study:

• To identify independent pre- and postoperative predictors of sternal dehiscence and infection.
• To analyze risk factors in the context of modern lung transplantation practices.

Main Methods:

• Retrospective review of 290 lung transplant patients who underwent sternotomy between 2018 and 2024.
• Comparison of a cohort of 33 patients with sternal complications against 257 patients without complications.
• Analysis of patient demographics, pre-operative conditions, surgical factors, and postoperative outcomes using univariate and multivariate logistic regression.

Main Results:

• The incidence of sternal dehiscence/infection was 11.4%, with a median reoperation interval of 99 days.
• Univariate analysis indicated higher risk in males, post-operative acute kidney injury (AKI), and veno-venous extracorporeal membrane oxygenation (ECMO) use.
• Multivariate analysis revealed female sex as protective (OR=0.39) and AKI as a significant risk factor (OR=2.67).

Conclusions:

• Sternal complications after lung transplantation are associated with male sex and post-operative renal failure (AKI).
• Female patients demonstrate a reduced risk of sternal complications.
• Identifying patients with these risk factors is crucial for implementing targeted strategies to prevent sternal complications and improve healing.