Complications after thoracic surgery: don't (necessarily) blame it on the approach

Chanoit, Guillaume

doi:10.1111/jsap.12089

Cited by 4 publications

(7 citation statements)

References 16 publications

(14 reference statements)

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“… 17 In the latter study, however, the thoracic approaches were not reported and most of the cats were treated for a diaphragmatic rupture. Overall, this survival rate could indicate that the MS approach cannot necessarily be linked to mortality, 8 although comparison between lateral thoracotomy and MS in a similar population is not available in cats. In dogs, retrospective comparison of MS and thoracotomy for the treatment of pulmonary neoplasia has shown that both approaches are acceptable for the treatment of this condition, even though thoracotomy was found to be associated with less postoperative pain, better oxygenation and fewer complications.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 5 – 7 However, whether this approach is associated with a higher occurrence of complications in dogs and cats is uncertain. 8 In humans, seroma formation, sternal osteomyelitis, surgical site infection, pain and sternal dehiscence are the main complications described after sternotomy, and have been associated with post-operative sternal instability. 9 , 10 Recent data gathered from a large cohort of dogs, comparing wire and suture closure, indicate that these complications are also associated with sternotomy closure.…”

Section: Introductionmentioning

confidence: 99%

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Closure-related complications after median sternotomy in cats: 26 cases (2010–2020)

Hennet

Pilot

Anderson

et al. 2022

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to determine closure-related complications and outcome after median sternotomy (MS) in cats. Methods This was a retrospective, multicentric study. The medical records of cats undergoing MS from six referral hospitals were reviewed (2010–2020). Data retrieved included signalment, history, presenting complaints, surgery, patient outcomes and complications. Follow-up was performed via patient records and email/telephone contact with both owners and referring veterinarians. Descriptive statistics were performed. Results Data on 36 cats were collected; four were excluded due to insufficient follow-up and six died less than 5 days after surgery. Twenty-six cats survived to discharge (survival rate 81%). Three cats had a full sternotomy (FS) performed and 23 cats a partial sternotomy (PS). Of the cats that underwent a PS, six included the manubrium (PSM) and three included the xyphoid process. For 14 cats, the length of sternotomy was unknown. Sternotomy closure was performed with suture in all cats. Two cats (7.7%) developed closure-related complications, both after PSM, during the long-term follow-up, one mild, slightly displaced sternal fracture and one severe, sternal dehiscence (without skin wound dehiscence) requiring revision surgery. No seroma, surgical site infection or wound dehiscence occurred. The most common reason for MS was the presence of a thoracic mass (17/26; 65%), with thymoma being the most common (11/17; 65%). Conclusions and relevance MS has a low closure-related complication risk in cats when compared with dogs. Complications in cats present differently to what has been previously described in dogs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Closure-related complications after median sternotomy in cats: 26 cases (2010–2020)

Hennet

Pilot

Anderson

et al. 2022

Journal of Feline Medicine and Surgery

Self Cite

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“…Support for the supposition that a sternotomy is inherently more problematic than a lateral thoracotomy is lacking. 21 It has been suggested that it is the fault of the underlying condition, not the approach, that is responsible for the potential bad reputation of the sternotomy. 21 The patient should be clipped from the midpoint of the neck to the umbilicus.…”

Section: Methodsmentioning

confidence: 99%

“…21 It has been suggested that it is the fault of the underlying condition, not the approach, that is responsible for the potential bad reputation of the sternotomy. 21 The patient should be clipped from the midpoint of the neck to the umbilicus. Laterally, the surgical site extends dorsally one-half the distance to the dorsal midline.…”

Section: Methodsmentioning

confidence: 99%

“…[16][17][18][19][20] Reasons for this disparity may include patient differences (veterinary patients rest in sternal recumbency compared with humans), less experienced veterinary surgeons, and lack of standard agreement of what constitutes a complication in veterinary surgical studies. 17,21 Many of the outcome results in reviews of median sternotomy may be more accurately attributed to the disease process rather than to the procedure itself.…”

Section: Median Sternotomy Indicationsmentioning

confidence: 98%

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Thoracic Surgery; Important Considerations and Practical Steps

Tillson

2015

Veterinary Clinics of North America: Small Animal Practice

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Comparison of median sternotomy closure‐related complication rates using orthopedic wire or suture in dogs: A multi‐institutional observational treatment effect analysis

et al. 2022

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Objective To determine and compare median sternotomy (MS) closure‐related complication rates using orthopedic wire or suture in dogs. Study design Multi‐institutional, retrospective observational study with treatment effect analysis. Animals 331 client‐owned dogs, of which 68 were excluded. Methods Medical records of dogs with MS were examined across nine referral centers (2004–2020). Signalment, weight, clinical presentation, surgical details, complications, and outcomes were recorded. Follow‐up was performed using patient records and email/telephone contact. Descriptive statistics, treatment effect analysis and logistic regression were performed. Results Median sternotomy closure was performed with wire in 115 dogs and suture in 148. Thirty‐seven dogs experienced closure‐related complications (14.1%), 20 in the wire group and 17 in the suture group. Twenty‐three were listed as mild, four as moderate and 10 as severe. Treatment effect analysis showed a mean of 2.3% reduction in closure‐related complications associated with using suture versus wire (95% CI: −9.1% to +4.5%). In multivariable logistic regression, the only factor associated with increased risk of closure‐related complications was dog size (p = .01). This effect was not modified by the type of closure used (interaction term: OR = 0.99 [95% CI: 0.96/1.01]). Conclusion The incidence of closure‐related complication after MS was low compared to previous reports. The likelihood of developing a closure‐related complication was equivalent between sutures and wires, independent of dog size, despite a higher proportion of complications seen in larger dogs (≥20 kg). Clinical significance Use of either orthopedic wire or suture appear to be an appropriate closure method for sternotomy in dogs of any size.

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Complications after thoracic surgery: don't (necessarily) blame it on the approach

Cited by 4 publications

References 16 publications

Closure-related complications after median sternotomy in cats: 26 cases (2010–2020)

Closure-related complications after median sternotomy in cats: 26 cases (2010–2020)

Thoracic Surgery; Important Considerations and Practical Steps

Comparison of median sternotomy closure‐related complication rates using orthopedic wire or suture in dogs: A multi‐institutional observational treatment effect analysis

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