Application of new rigid sternal plates and prediction of sternal dehiscence in high-risk patients

Abstract

Background: Sternal dehiscence is a serious complication of cardiac surgery that has been a clinically intractable problem. The study aimed to explore the advantages of new rigid sternal plates (NRSP) compared with wire cerclage (WC) in the cardiac surgery of high- risk patients with sternal dehiscence and summarize the application experience. Methods: A retrospective analysis was performed on high-risk patients for sternal dehiscence who underwent cardiac surgery operation in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021. All cases were identified and divided into WC (n=276) and NRSP (n=291). Risk factors for sternal complications, postoperative outcomes and cost associated with surgery and subsequent treatment were analyzed. Results: There was no significant difference in demographics and preoperative comorbidities compared to patients with WC(p＞0.05), those with NRSP had longer sternal closure time(p＜0.001). However, there are shorter hospital length of stay(p＜0.001), less postoperative drainage volume of 24h (p＜0.001), and lower total costs at 6 months(p=0.043) and 12 months(p＜0.001) in NRSP patients. After multivariate logistic regression analysis, the remaining five independent risk factors for the development of sternal dehiscence were used to compose the nomogram. The area under the receiver operating characteristic curve (AUC) of the model was 0.865 (95% confidence interval [CI], 0.802–0.927), and the calibration curve was good by the Hosmer–Lemeshow test. Conclusions: NRSP can enhance the stability of sternal fixation in high-risk patients after cardiac surgery and reduce the risk of sternal complications. Moreover, the nomogram comprised of age, body mass index (BMI)＞30kg/m , diabetes mellitus(DM), chronic obstructive pulmonary disease (COPD) and sternal closure method may predict the risk of sternal dehiscence.