title: Postoperative sternal dehiscence in obese patients: incidence and prevention.
abstract: BACKGROUND
  Obesity has been identified as the single most important risk factor for postoperative sternal infection in coronary bypass surgery patients. It is also a major risk factor for sternal dehiscence, with or without infection, for any type of cardiac operation. We assessed whether prophylactic measures could prevent this complication.
  
  
  METHODS
  Two studies were conducted. In study A, 3,158 heart surgery patients were analyzed at 3 cardiac units. Obesity was defined as body mass index (BMI) more than 30. Group I (1,253 obese [39.7%]) was compared with group II (1,905 nonobese [60.3%]). Sternal closure was done at the surgeon's preference: (a) plain wires through and through the bone; (b) peristernal figure-of-eight wires; or (c) peristernal method, using stainless-steel cables. In study B, 123 obese patients were prospectively divided into 2 subgroups. Group B-1 (54 patients) underwent lateral prophylactic sternal reinforcement before placement of peristernal wires. Group B-2 (69 patients) had standard sternal closure, as in study A.
  
  
  RESULTS
  In study A, group I had 81 dehiscences (6.46%); 78 also suffered deep sternal infection and mediastinitis (96%). Despite treatment, dehiscence recurred in 13, and mortality was 38.4%. In group II nonobese patients, 31 dehisced (1.6%, p = 0.000), with no mortality. In study B, group B-1 (54) had 0% dehiscence versus group B-2 (69) with 6 dehiscences (8.7%).
  
  
  CONCLUSIONS
  In our study, the rate of obesity is high ( approximately 40%). Sternal dehiscence is real when the BMI is more than 30 (6.46%), and has high morbidity and mortality. Prophylactic sternal reinforcement seems to prevent this complication.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA. molin001@umn.edu
authors.forename: J Ernesto
authors.initials: JE
authors.lastname: Molina
authors.forename: Rachel Saik-Leng
authors.initials: RS
authors.lastname: Lew
authors.forename: Kasi J
authors.initials: KJ
authors.lastname: Hyland
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000601:surgery*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota; D009765:Obesity / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000517:prevention & control*; D015996:Survival Rate