Key result
In high-risk patients with diabetes and COPD undergoing cardiac surgery, using fewer than 7 sternal wires was associated with a higher rate of sternal complications (15% vs 5%, p=0.04).
Why the study?
Does the use of <7 sternal wires increase sternal complications in adult patients undergoing cardiac surgery?
Cohort (n=4,466)
No
Does the use of <7 sternal wires increase sternal complications in adult patients undergoing cardiac surgery?
Absolute Event Rate: 15% vs 5%
p-value: p=0.04
In high-risk cardiac surgery patients with diabetes and COPD, using 7 or more sternal wires for chest closure significantly reduces the risk of sternal complications.
Should not yet change sternal closure practice; hypothesis-generating for ≥7 wires in high-risk diabetic COPD patients.
Aims: Sternal dehiscence and mediastinitis are rare but serious complications following cardiac surgery. The aim of this study was to investigate influence of number of sternal wires used for chest closure on sternal complications. Methods: From May 2003 to April 2007, 4714 adult patients received cardiac surgery in our institute. X-rays in all the patients were checked and the used wires were counted. Of them, patients who received another material or longitudinal wiring technique according to Robicsek for chest closure were excluded from this analysis. Thus, 4466 patients were included into final analysis. Figure-of-eight wiring was counted as 2 wires. Results: Occurrence of sternal complications was 2.4%, and hospital mortality with and without sternal complications were 2.8% and 2.7%, respectively (p=0.60). Mean numbers of sternal wires were 7.8 in both patient groups with or without sternal complications (p=0.79). Multivariate analysis revealed diabetes mellitus (OR 1.6, 95% CL 1.3–2.4, p=0.029), chronic obstructive pulmonary disease (OR 1.9, 95% CL 1.3–3.0, p=0.001), renal insufficiency (OR 1.6, 95% CL 1.1–2.6, p=0.025), re-thoracotomy due to postoperative bleeding (OR 4.3, 95% CL 2.6–7.1, p=0.0001) as significant risk factors for sternal complications. In patients with both diabetes mellitus and chronic obstructive pulmonary disease (n=280), the number of sternal wires <7 was associated to higher occurrence of sternal complications (15%, 5/34pts vs. 5%, 12/246pts; p=0.04). Conclusions: Especially in high risk patients, careful hemostasis and use of more than 7 wires should be done to avoid sternal complications.
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Al-maisary et al. (2009) conducted a cohort in Cardiac surgery (n=4,466). Fewer than 7 sternal wires vs. 7 or more sternal wires was evaluated on Sternal complications in high-risk patients (diabetes and COPD) (p=0.04). In high-risk patients with diabetes and COPD undergoing cardiac surgery, using fewer than 7 sternal wires was associated with a higher rate of sternal complications (15% vs 5%, p=0.04).
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