Document Detail


The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients.
MedLine Citation:
PMID:  22771480     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Sternal dehiscence and mediastinitis are rare but serious complications following cardiac surgery. The aim of this study was to investigate the influence of the number of sternal wires used for chest closure on sternal complications.
METHODS: From May 2003 to April 2007, 4714 adult patients received cardiac surgery in our institute. X-ray images of all patients were reviewed and the used wires were counted. Patients who received another material or longitudinal wiring technique according to Robicsek for chest closure were excluded from this analysis; thus 4466 patients were included into the final analysis. Figure-of-eight wiring was counted as two wires.
RESULTS: Sternal complications occurred in 2.4%, and hospital mortality with or without sternal complications were 2.8 and 2.7%, respectively (P = 0.60). Mean numbers of sternal wires were 7.8 in both patient groups with or without sternal complications (P = 0.79). Multivariate analysis revealed diabetes mellitus [odds ratio (OR) 1.54, 95% CI 1.01-2.34, P = 0.04], chronic obstructive pulmonary disease (OR 1.85, 95% CI 1.12-2.79, P = 0.01) and renal insufficiency (OR 1.70, 95% CI 1.11-2.59, P = 0.001) as significant risk factors for sternal complications. In high-risk patients, the use of less than eight wires was significantly associated with postoperative sternal complications.
CONCLUSIONS: Particularly in high-risk patients, careful haemostasis should be done and eight or more wires should be used to avoid sternal complications.
Authors:
Hiroyuki Kamiya; Sameer S A Al-maisary; Payam Akhyari; Arjang Ruhparwar; Klaus Kallenbach; Artur Lichtenberg; Matthias Karck
Publication Detail:
Type:  Journal Article     Date:  2012-07-06
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-19     Completed Date:  2013-02-08     Revised Date:  2013-10-11    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  665-70     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, University of Düsseldorf, Düsseldorf, Germany. hkamiya88@yahoo.co.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Bone Wires*
Cardiac Surgical Procedures*
Chi-Square Distribution
Diabetes Complications / etiology
Female
Heart Diseases / complications,  mortality,  surgery*
Hospital Mortality
Humans
Logistic Models
Male
Mediastinitis / etiology
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications / etiology*,  mortality,  radiography
Pulmonary Disease, Chronic Obstructive / complications
Renal Insufficiency / complications
Retrospective Studies
Risk Assessment
Risk Factors
Sternotomy / adverse effects*,  mortality
Surgical Wound Dehiscence / etiology
Surgical Wound Infection / etiology
Treatment Outcome
Wound Closure Techniques / adverse effects*,  instrumentation*,  mortality
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):670   [PMID:  22991394 ]

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


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