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

Balachandran, Sulakshana; Lee, Annemarie L.; Denehy, Linda; Lin, Kun-You; Royse, Alistair; Royse, Colin; El-Ansary, Doa

doi:10.1016/j.athoracsur.2016.05.047

Cited by 87 publications

(96 citation statements)

References 62 publications

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“…However, we found that obesity remained independently associated with risk for delirium even after adjusting for the presence of PGD at 48 or 72 hours. Notably, obesity has been associated with increased incidence of sternal wound infections, prolonged ventilation, and increased rate of renal failure in cardiothoracic surgeries 26,27 . These complications can also lead to development of delirium in surgical populations.…”

Section: Discussionmentioning

confidence: 99%

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

et al. 2017

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Background Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized. Methods The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and one-year mortality. Results Thirty six % developed early-onset and 44% - ever-onset delirium. Obesity (OR 6.35, 95% CI 1.61–24.98) and bolused benzodiazepines within the first post-operative day (OR 2.28, 95% CI 1.07–4.89) were associated with early-onset delirium. Early-onset delirium was associated with longer adjusted mechanical ventilation duration (p=0.001), ICU LOS (p<0.001), and hospital LOS (p=0.005). Ever-onset delirium was associated with longer ICU (p<0.001) and hospital LOS (p<0.001). After adjusting for clinical variables, delirium was not significantly associated with one-year mortality (early-onset HR 1.65, 95% CI 0.67–4.03; ever-onset HR 1.70, 95% CI 0.63–4.55). Conclusions Delirium is common after lung transplant surgery and associated with increased hospital resources.

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Section: Discussionmentioning

confidence: 99%

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

et al. 2017

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Section: Introductionmentioning

confidence: 99%

“…Despite these advantages, the incidence of sternal complications has remained relatively unchanged for the last 2 decades and is reported to be between 0.4% and 8% worldwide [8–11]. Sternal complications include dehiscence, wound infection, sternal instability/non-union and mediastinitis [11]. These complications are associated with significant morbidity and prolonged hospital length of stay, and they contribute to increased health care costs [8, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…Sternal complications include dehiscence, wound infection, sternal instability/non-union and mediastinitis [11]. These complications are associated with significant morbidity and prolonged hospital length of stay, and they contribute to increased health care costs [8, 11, 12]. …”

Section: Introductionmentioning

confidence: 99%

“…The secondary aims are (1) to evaluate the effectiveness of modified sternal precautions compared with standard care on sternal pain and discomfort, kinesiophobia and health-related quality of life (HRQoL) at 4 weeks and 3 months post-operatively, as well as on physical function at 3 months post-operatively; (2) to measure participants’ adherence to sternal precautions; and (3) to explore whether demographic factors, co-morbidities and/or pre, peri- and post-operative risk factors are associated with the development of post-sternotomy complications. This will be an exploratory analysis which may identify trends of predictors reported in the literature [11]. …”

Section: Introductionmentioning

confidence: 99%

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The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial

Katijjahbe

Denehy

Granger

et al. 2017

Trials

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BackgroundThe routine implementation of sternal precautions to prevent sternal complications that restrict the use of the upper limbs is currently worldwide practice following a median sternotomy. However, evidence is limited and drawn primarily from cadaver studies and orthopaedic research. Sternal precautions may delay recovery, prolong hospital discharge and be overly restrictive. Recent research has shown that upper limb exercise reduces post-operative sternal pain and results in minimal micromotion between the sternal edges as measured by ultrasound. The aims of this study are to evaluate the effects of modified sternal precautions on physical function, pain, recovery and health-related quality of life after cardiac surgery.Methods/designThis study is a phase II, double-blind, randomised controlled trial with concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. Patients (n = 72) will be recruited following cardiac surgery via a median sternotomy. Sample size calculations were based on the minimal important difference (two points) for the primary outcome: Short Physical Performance Battery. Thirty-six participants are required per group to counter dropout (20%). All participants will be randomised to receive either standard or modified sternal precautions. The intervention group will receive guidelines encouraging the safe use of the upper limbs. Secondary outcomes are upper limb function, pain, kinesiophobia and health-related quality of life. Descriptive statistics will be used to summarise data. The primary hypothesis will be examined by repeated-measures analysis of variance to evaluate the changes from baseline to 4 weeks post-operatively in the intervention arm compared with the usual-care arm. In all tests to be conducted, a p value <0.05 (two-tailed) will be considered statistically significant, and confidence intervals will be reported.DiscussionThe Sternal Management Accelerated Recovery Trial (S.M.A.R.T.) is a two-centre randomised controlled trial powered and designed to investigate whether the effects of modifying sternal precautions to include the safe use of the upper limbs and trunk impact patients’ physical function and recovery following cardiac surgery via median sternotomy.Trial registrationAustralian and New Zealand Clinical Trials Registry identifier: ACTRN12615000968572. Registered on 16 September 2015 (prospectively registered).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1974-8) contains supplementary material, which is available to authorized users.

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The role of negative pressure wound therapy in the treatment of poststernotomy mediastinitis in Asians: A single‐center, retrospective cohort study

Wang,

Lee,

Chiang

et al. 2023

Health Science Reports

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IntroductionPoststernotomy mediastinitis (PSM) is a critical and life‐threatening complication that can arise after cardiac surgery. The aim of this study was to evaluate and compare the outcomes of negative pressure wound therapy (NPWT) and conventional methods in the management of mediastinitis following heart surgery with a focus on Asian populations.MethodsFor this retrospective study, we included and evaluated a total of 34 patients who had undergone cardiac operations between January 2011 and September 2021 and developed PSM. The patients were divided into two groups, the NPWT group (n = 16, 47.1%) and the conventional treatment group (n = 18, 52.9%), and compared.ResultsThe two groups showed no significant differences in terms of patient characteristics, PSM wound classification based on the El Oakley classification, and wound closure methods, but there was a higher incidence of diabetes mellitus in the NPWT group. With regard to mediastinal cultures, a higher prevalence of Staphylococcus epidermidis was observed in the NPWT group. However, we found no significant differences between the two groups regarding the time interval from diagnosis to wound closure, hospitalization duration, and re‐exploration rate. Notably, the NPWT group exhibited a significantly higher in‐hospital mortality rate than the conventional treatment group (p = 0.024).ConclusionsOur findings suggest that the use of NPWT might not lead to improved medical outcomes for patients with PSM when compared to conventional treatment methods. As a result, it becomes imperative to exercise great care when choosing patients for NPWT. To obtain more definitive and conclusive results and identify the most appropriate cases for NPWT, conducting larger randomized clinical trials is necessary.

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

Cited by 87 publications

References 62 publications

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial

The role of negative pressure wound therapy in the treatment of poststernotomy mediastinitis in Asians: A single‐center, retrospective cohort study

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