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

Sternal wound dehiscence and infection affect up to one-third of lung transplant recipients and are associated with mediastinitis, prolonged hospitalization, impaired graft function, and increased mortality. Despite advances in perioperative care, contemporary data on the patient- and procedure-related risk factors for these complications after lung transplantation remain scarce. Therefore, this study aimed to identify independent pre- and postoperative predictors of sternal dehiscence/infection in modern lung-transplant practice.

A retrospective review of the lung transplant database identified 290 consecutive patients who underwent lung transplantation with sternotomy from 2018 to 2024. A cohort of 33 with sternal dehiscence/infection and 257 patients without sternal complications were compared. The patient demographics, pre-operative medical conditions, surgical factors, and postoperative outcomes were analyzed. Univariate and multivariate logistic regression analysis was used to predict sternal complications after lung transplantation.

The incidence of sternal dehiscence/infection was 11.4%, and the median interval between initial lung transplantation and reoperation for sternal complications was 99 days. In the univariate analysis, the sternal complication was more common in men, patients who developed postoperative acute kidney injury (AKI), and required post-operative veno-venous extracorporeal membrane oxygenation (ECMO). The multivariate analysis showed preoperative factors such as being female were associated with a lower risk of sternal complications [odds ratio (OR) =0.39; 95% confidence interval (CI): 0.16-0.94; P=0.04] while post-operative complications such as AKI increased the risk for sternal complications (OR =2.67; 95% CI: 1.08-6.61; P=0.03).

Sternal complications after lung transplantation were associated with patient factors such as male and post-operative complications such as renal failures. Patients with these risk factors may develop impaired sternal healing, requiring additional measurements to prevent sternal complications.