Prevention of Sternal Dehiscence and Infection in High-Risk Patients: A Prospective Randomized Multicenter Trial

• Published in: The Annals of thoracic surgery Vol. 86; no. 6; pp. 1897 - 1904
• Main Authors: Schimmer, Christoph, MD, Reents, Wilko, MD, Berneder, Silvia, MD, Eigel, Peter, MD, Sezer, Oemer, MD, Scheld, Hans, MD, Sahraoui, Kerim, Gansera, Brigitte, MD, Deppert, Oliver, MD, Rubio, Alvaro, Feyrer, Richard, MBA, Sauer, Cathrin, Elert, Olaf, MD, Leyh, Rainer, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2008; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone Wires; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Follow-Up Studies; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Pneumology; Probability; Prospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Sternum - surgery; Surgery; Surgical Wound Dehiscence - prevention & control; Surgical Wound Dehiscence - therapy; Surgical Wound Infection - prevention & control; Surgical Wound Infection - therapy; Suture Anchors; Suture Techniques; Tensile Strength; Thoracotomy - adverse effects; Thoracotomy - methods; Treatment Outcome; Wound Healing - physiology; 5; Human; Prospective; High risk; Chemoprophylaxis; Randomization; Sternum; Multicenter study; Dehiscence; Anesthesia; Patient; Circulatory system; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.08.071

Background One factor for the development of sternal wound infection (SWI) is bony instability after sternotomy. This study compares two surgical techniques with respect to the occurrence of SWI in patients with an increased risk. Methods In this multicenter study, 815 consecutive patients with an increased risk for SWI were prospectively randomly assigned to a conventional osteosynthesis (transsternal or peristernal wiring; n = 440) or to an osteosynthesis with additional lateral reinforcement (Robicsek; n = 375). Primary endpoints were the rate of sternal dehiscence as well as the occurrence of superficial sternal wound infections and deep sternal wound infections. Results Both groups were comparable concerning preoperative and intraoperative variables. The rate of sternal dehiscence, superficial sternal wound infections, and deep sternal wound infections (conventional technique 2.5%, 3.4%, 2.5%; and Robicsek 3.7%, 5.6%, 3.7%) did not differ between the groups. Logistic regression analysis found independent risk factors for the development of sternal dehiscence: body mass indes greater than 30 kg/m2 (odds ratio [OR]: 2.9; p = 0.05), New York Heart Association class more than III (OR: 2.4; p = 0.07), impaired renal function (OR: 3.9; p = 0.01), peripheral arterial disease (OR: 3.6; p = 0.001), immunosuppressant state (OR: 3.3; p = 0.001), sternal closure performed by an assistant doctor (OR: 2.5, p = 0.004), postoperative bleeding (OR: 4.2; p = 0.03), transfusion of more than 5 red blood units (OR: 3.7, p = 0.01), reexploration for bleeding (OR: 6.9, p = 0.001), and postoperative delirium (OR: 3.5, p = 0.01). There was an inverse relation between the numbers of wires and DSWI in patients with conventional sternal closure ( p = 0.008). Conclusions In patients with an increased risk for sternal instability and wound infection after cardiac surgery, sternal reinforcement according to the technique described by Robicsek did not reduce this complication.