Value of Perioperative Chest X-ray for the Prediction of Sternal Wound Complications after Cardiac Surgery in High-Risk Patients: A “Work in Progress” Analysis

Abstract

Background. Sternal wound complications are serious events that occur after cardiac surgery. Few studies have investigated the predictive value of chest X-ray radiological measurements for sternal complications. Methods. Several perioperative radiological measurements at chest X-ray and clinical characteristics were computed in 849 patients deemed at high risk for sternal dehiscence (SD) or More than Grade 1 Surgical Site Infection (MG1-SSI). Multivariable analysis identified independent predictors, whilst receiver operating characteristics (ROC) curve analyses highlighted cut-off values of radiological measurements for the prediction of both complications. Results. SD occurred in 8.8% of the patients, MG1-SSI in 6.8%. Chronic obstructive pulmonary disease (COPD) was the only independent predictor for SD (Odds Ratio, O.R. 12.1; p < 0.001); proximal sternal height (PSH) was the only independent protective factor (O.R. 0.58; p < 0.001), with a cut-off value of 11.7 mm (sensitivity 70.5%, specificity 71.0%; ROC area under the curve (AUC) = 0.768, p < 0.001). Diabetes mellitus (O.R. 3.5; p < 0.001) and COPD (O.R. 21.3; p < 0.001) were independent predictors for MG1-SSI; indexed proximal sternal height (iPSH) was as a protective factor (O.R. 0.26; p < 0.001) with a cut-off of 5.97 mm (sensitivity 70.2%, specificity 69.0%; ROC AUC = 0.739, p < 0.001). No other radiological measurements were independently correlated with SD or MG1-SS (p = N.S.). Conclusion. PSH and iPSH at preoperative chest X-ray may act as indicators of high risk for sternal wound complications, allowing for early preventative measures.

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

“…Sternal dehiscence is a serious complication affecting the prognosis and quality of life of patients with cardiac surgery, several previous models focus on the risk of DSWI after bilateral internal thoracic artery grafting or preventing infections on multiple surgical sites. [19][20][21] In this context, We have established a novel nomogram, which is composed of age, BMI¿30kg/m 2 , DM, COPD and sternal closure method, to predict sternal dehiscence in high-risk patients. These variables are easily obtainable which allows for the prediction of sternal dehiscence and the nomogram is designed for simplicity and easy application in clinical practice.…”

“…The initial hospitalization costs, examination costs, treatment costs, total healthcare costs at 6 months and 12 months for all high-risk sternotomy patients is summarized in table 4. NRSP group had greater costs associated with their hospitalization compared with WC group($22,459 [19,469] vs $20,067 [17,,610], p¡0.001), driven primarily by the initial costs of NRSP. There was a non-significant trend in the costs of pharmacy, ICU, laboratory and imaging with or without NRSP(p¿0.05).…”

Radiographic methods in diagnostics of infectious diseases of the sternum and ribs

“…A. Ardigò и соавт. считают, что ее целесообразно выполнять всем пациентам перед открытой операцией на сердце с целью прогнозирования риска развития ПСМ [11]. Данный метод диагностики полезен и в послеоперационном периоде, он позволяет визуализировать и оценить количество металлических лигатур на грудине, их положение и взаимоотношение с ней [12].…”