Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

Abstract

SummarySternal dehiscence following cardiac surgery has a multifactorial etiology. Significant risk factors contributing to sternal dehiscence include chronic obstructive pulmonary disease (COPD), obesity, or re-exploration due to bleeding or pericardial tamponade. We have focused on the role of allogeneic blood transfusion as a factor leading to the poor healing of surgical wounds.A prospective observational study of 1553 elective and emergency cardiac surgery patients was performed between January 2003 and June 2007. All of the patients enrolled in this study underwent median sternotomy. We studied the relationship between sternal dehiscence following cardiac surgery and the total number of packed red blood cells transfused.The incidence of sternal dehiscence in the study group was 3.4%. Diabetic patients did not have a higher incidence of wound dehiscence. Although COPD, 2) obesity, 2) and re-exploration 4) contributed to sternal dehiscence, the number of allogeneic blood transfusions during the perioperative period was an important independent risk factor for sternal dehiscence. Patients with sternal dehiscence received an average of 7.6 transfusion units (TU) of allogeneic blood versus 1.6 TU of allogeneic blood in the group without sternal dehiscence (P < 0.00005). The dehiscence affected patients without any other significant risk factor who received 6 or more TU, or patients with at least one significant risk factor who received 4 or more TU of allogeneic blood. According to our results, the total amount of allogeneic blood transfused is an important risk factor contributing to sternal dehiscence. Regardless of other risk preconditions, the transfusion of 6 or more TU could result in sternal dehiscence following cardiac surgery. (Int Heart J 2009; 50: 601-608)

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

“…Studies of sternal wound healing and perioperative blood transfusion in combat casualties both link volume of blood transfusion with impaired wound healing, higher infection rates, and longer hospital stay. 35,36 This may well play a role in the results of this study.…”

Complications in cardiac surgery: An analysis of factors contributing to sternal dehiscence in patients who underwent surgery between 2010 and 2014 and a comparison with the 1990–2009 cohort

“…[13][14][15][16][17] Postoperative factors that may increase the risk of sternal dehiscence include chest compression during resuscitation, intensive cough among tobacco smokers and patients with COPD, but also intake of specific medicines. 18,19 In addition, other lung complications that result in strong cough, prolonged intubation and mechanical ventilation may increase the risk of sternal dehiscence. The most serious complication that In total 45 0.9 5,152 * Valve procedures performed together with aortic aneurysm repair were treated as aneurysm repair procedures.…”

Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review

“…The resulting sternal instability may predispose these patients to the development of postoperative sternal infection [2,8,16]. Furthermore, decreased vascularity of fatty tissue may lead to impaired wound nutrition and increase the risk of sternal infection in obese patients after cardiac operations [29,32,59]. An alternative suggestion is that the prophylactic antibiotic therapy provided to obese patients undergoing cardiac operations is inadequate, thus increasing their susceptibility to the development of sternal infection [29].…”