Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature

Scott, N. Morrell; Lotto, Robyn; Spencer, E.; Grant, Maria J.; Penson, Peter E.; Jones, Ian

doi:10.1016/j.hrtlng.2022.04.013

Cited by 3 publications

(2 citation statements)

References 58 publications

(155 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although safe, the invasiveness of sternotomy may be complicated by infection with potential catastrophic consequences, inadvertent sternal fracture during retraction, and chronic pain due to sternal nonunion, inevitably causing delay in return to normal physical activity. 1,2 Alternatively, minimally invasive (MICS) CABG provides a sternal-sparing approach, which can eliminate some of the complications of sternotomy while not compromising safety and graft patency when performed by an experienced surgeon. 3,4 However, it has been recognized that MICS is technically more demanding and has a steep learning curve to overcome.…”

Section: Introductionmentioning

confidence: 99%

Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept

Azmi,

Nair,

Hashim

2024

Innovations�(Phila)

View full text Add to dashboard Cite

Objective: We evaluated the effectiveness of a consistent and structured self-practice coronary anastomosis program using a homemade low-fidelity beating-heart simulator. Methods: An intermediary trainee was subjected to an 8-week structured self-practice program. The program was divided into 2 parts of nonbeating and beating practices with a minimum number of timed anastomoses. Each part was followed by an assessment using an objective skills assessment tool score. The beating-heart simulator was built using motorized toy blocks connected wirelessly to a smartphone application. This was coded to enable rate selection. A junior consultant was compared to the subject at the end of the program. Both were tasked to perform 1 coronary anastomosis for both off-pump coronary artery bypass (OPCAB) and minimally invasive CAB (MICS) setup. The primary outcomes were anastomotic time and score compared with the junior consultant. Secondary outcomes were progression of anastomotic time and score throughout the program. Results: Overall performance of the studied subject approached the performance of the junior consultant in terms of time (OPCAB, 489 vs 605 s; MICS, 712 vs 652 s) and scores (OPCAB, 21 vs 20.7; MICS, 19 vs 20.6). There were inverse correlations between anastomosis time and number of practices for both nonbeating and beating anastomoses. Overall improvement was observed in terms of assessment scoring by 26.6%. Conclusions: A structured self-practice program using an affordable and accessible simulator was able to help trainees overcome the MICS anastomosis learning curve quicker when introduced earlier. This may encourage earlier adoption of MICS among surgeons.

show abstract

Section: Introductionmentioning

confidence: 99%

Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept

Azmi,

Nair,

Hashim

2024

Innovations�(Phila)

View full text Add to dashboard Cite

show abstract

“…Currently, midline sternotomy is a widespread method for direct thorax access [ 1 ], and despite advancements in minimally invasive surgery, the majority of complex cardiac procedures are performed through midline sternotomy. Albeit rare (0.5–5%), complications of midline sternotomy such as sternal wound infection (SWI), sternal wound dehiscence, repeat sternotomy, mortality, prolonged hospital stay and increased hospital costs were described in different patient series [ 2–4 ].…”

Section: Introductionmentioning

confidence: 99%

Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis

Caldonazo,

Dell’Aquila,

Cancelli

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

OBJECTIVES Midline sternotomy is the main surgical access for cardiac surgeries. The most prominent complication of sternotomy is sternal wound infection (SWI). The use of a thorax support vest (TSV) that limits thorax movement and ensures sternal stability has been suggested to prevent postoperative SWI. We performed a meta-analysis to evaluate differences in clinical outcomes with and without the use of TSV after cardiac surgery in randomized trials. METHODS The primary outcome was deep SWI (DSWI). Secondary outcomes were superficial SWI (SSWI), sternal wound dehiscence, and hospital length of stay (LOS). A trial sequential analysis (TSA) was performed. Fixed (F) and random effects (R) model were calculated. RESULTS A total of 4 studies (3,820 patients) were included. Patients who wore the TSV had lower incidence of DSWI (OR= F : 0.24, 95% CI, 0.13–0.43, p < 0.01; R : 0.24, 0.04–1.59, p = 0.08), of sternal wound dehiscence (OR= F : 0.08, 95% CI, 0.02–0.27, p < 0.01; R : 0.10, 0.00–2.20, p = 0.08) and shorter hospital LOS (SMD= F:-0.30, -0.37 to -0.24, p < 0.01; R:-0.63, -1.29 to 0.02, p = 0.15). There was no difference regarding the incidence of SSWI (OR= F : 0.71, 95% CI, 0.34–1.47, p = 0.35; R : 0.64, 0.10, 4.26, p = 0.42). The TSA however showed that the observed decrease in DSWI in TSV arm cannot be considered conclusive based on the existing evidence. CONCLUSIONS This meta-analysis suggests that the use of a TSV after cardiac surgery could potentially be associated with a reduction in sternal wound complications. However, despite the significant treatment effect in the available studies, the evidence is not solid enough to provide strong practice recommendations.

show abstract

Device infection in cardiac surgery patients: adding insult to injury

Zeitler

Iribarne

2022

J Interv Card Electrophysiol

View full text Add to dashboard Cite

Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature

Cited by 3 publications

References 58 publications

Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept

Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept

Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis

Device infection in cardiac surgery patients: adding insult to injury

Contact Info

Product

Resources

About