Document Detail


Sternal closure techniques and postoperative sternal wound complications in elderly patients.
MedLine Citation:
PMID:  18468447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Postoperative sternal wound complications (PSWC) including deep sternal wound infection (DSWI) and sternal dehiscence (SD) cause significant morbidity and mortality. Elderly patients with several risk factors are particularly prone to suffer PSWC. METHODS: We present (I) a subset of 86 patients, all aged > or =75 years out of 339 cardiac surgery patients prospectively randomised to receive either conventional sternal closure or a Robicsek type closure. Primary end-points were SD and DSWI; secondary end-points included a composite of clinical parameters; (II) we retrospectively assessed data of 54/5273 patients with mediastinitis regarding the influence of advanced age. In addition, we report an epidemiological overview of different sternal closure techniques. RESULTS: (I) The Robicsek technique showed an impact on SD and DSWI, and several secondary end-points: ventilator support (p=0.03), postoperative blood loss (p=0.04), and chest pain >3 days (p=0.04). (II) A total of 54/5273 (1.02%) patients developed postoperative mediastinitis. Twelve out of 54 (22%) patients died within 6 months of the initial operation. Predictors of mortality were insulin-dependent diabetes mellitus (p=0.05), renal insufficiency (p=0.01), delayed sternal closure (p=0.05), ICU-stay >10 days (p=0.01), and methicillin-resistant Staphylococcus aureus (p=0.03) or fungal infection (p=0.02). CONCLUSIONS: No statistical difference in sternal dehiscence or mediastinitis was found irrespective of whether the bilateral and longitudinal parasternal closure or the conventional peri/trans-sternal wiring technique was used, but there was an obvious, positive influence on sternal dehiscence, deep sternal wound infection, and clinical parameters. However, the study population is relatively small.
Authors:
Christoph Schimmer; Sebastian-Patrick Sommer; Marc Bensch; Thomas Bohrer; Ivan Aleksic; Rainer Leyh
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-05-09
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  34     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-30     Completed Date:  2008-12-04     Revised Date:  2009-03-12    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  132-8     Citation Subset:  IM    
Affiliation:
University of Würzburg, Department of Cardiac and Thoracic Surgery, Würzburg, Germany. Schimmer_c@klinik.uni-wuerzburg.de <Schimmer_c@klinik.uni-wuerzburg.de>
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Bone Wires
Cardiac Surgical Procedures
Female
Humans
Male
Mediastinitis / etiology*,  prevention & control
Prospective Studies
Retrospective Studies
Risk Factors
Sternum / surgery*
Surgical Wound Dehiscence / etiology*,  prevention & control
Surgical Wound Infection / etiology*,  prevention & control
Suture Techniques*
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2008 Nov;34(5):1127-8; author reply 1128   [PMID:  18760932 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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