Original article
Cardiovascular
Clinical Outcomes of Noninfectious Sternal Dehiscence After Median Sternotomy

https://doi.org/10.1016/j.athoracsur.2006.04.058Get rights and content

Background

Infectious complications of median sternotomy carry significant morbidity and mortality. However, the outcomes of noninfectious sternal dehiscence have not been addressed. We have identified the preoperative characteristics, postoperative complications, and long-term functional outcomes of patients after reoperation for noninfectious sternal dehiscence and compared these patients with a control group to determine risk factors for dehiscence.

Methods

Retrospective review of the cardiac surgery database identified 48 patients with noninfectious sternal dehiscence in a group of 12,380 median sternotomies between 1994 and 2004. The review included diagnosis, demographics, concomitant medical conditions, and surgical outcomes. Functional outcomes were assessed using the Short Form-12 questionnaire. One hundred fifty-six median sternotomy patients served as controls. Follow-up was 97.9% (47 of 48 patients) complete, for a total of 150.1 patient-years.

Results

Mean age of patients at reoperation was 58.8 ± 12.8 years, with a male to female ratio of 45:3. Multivariate analysis determined that New York Heart Association class IV, obesity, and chronic obstructive pulmonary disease were preoperative risk factors for sternal dehiscence. The incidence of sternal dehiscence was 0.39% at a mean interval between initial operation and reoperation of 5.4 months. At a mean interval of 3.9 months, 14.6% (7 of 48) of patients required additional sternal procedures. Infectious complications after reoperation occurred in 12.5% (6 of 48). Functional outcomes demonstrated that 72.2% (26 of 36) had no or mild limitation of physical activities, with 90.5% (38 of 42) reporting no or mild sternal pain at follow-up.

Conclusions

Although patients undergoing surgical correction of noninfectious sternal dehiscence fare better than those with infectious complications, optimal sternal approximation during the initial procedure and sternal precautions during convalescence should be emphasized to prevent recurrent complications.

Section snippets

Patients and Methods

A retrospective review was performed of all patients undergoing median sternotomy for cardiac surgery at The Johns Hopkins Hospital from March 1994 to February 2004. A total of 12,380 median sternotomies were performed during the study period, and 48 patients (0.39%) underwent surgery to repair a noninfectious sternal dehiscence. Patients who experienced infectious complications of the sternal wound after sternotomy were excluded. Age, sex, race, and procedure-matched controls who underwent

Results

During this period, a total of 12,380 median sternotomies were performed, with an incidence of noninfectious sternal dehiscence of 0.39% (48 of 12,380). The incidence of infectious sternal dehiscence during the same period was 2.4% (298 of 12,380). Our patient cohort consisted of 48 patients (48 of 12,380, 0.39%) who suffered from noninfectious sternal dehiscence after median sternotomy, with a mean age of 58.8 ± 12.8 years (range, 30 to 79) at reoperation and a male to female ratio of 45:3 (

Comment

The purpose of this study was to identify the preoperative characteristics, postoperative complications, and long-term functional outcomes of patients undergoing sternal reoperation from noninfectious causes and to compare these patients with a group of age-, sex-, race-, and procedure-matched control subjects to determine risk factors for noninfectious sternal dehiscence. Previous studies have addressed these issues for patients having sternal dehiscence from infectious causes. Although the

Requirements for Recertification/Maintenance of Certification in 2006

Diplomates of the American Board of Thoracic Surgery who plan to participate in the Recertification/Maintenance of Certification process in 2006 must hold an active medical license and must hold clinical privileges in thoracic surgery. In addition, a valid certificate is an absolute requirement for entrance into the recertification/maintenance of certification process. if your certificate has expired, the only pathway for renewal of a certificate is to take and pass the Part I (written) and the

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