Clinical outcomes of noninfectious sternal dehiscence after median sternotomy.
BACKGROUND
Infectious complications of median sternotomy carry significant morbidity and mortality. However, the outcomes of noninfectious sternal dehiscence have not been addressed. We have identified the preoperative characteristics, postoperative complications, and long-term functional outcomes of patients after reoperation for noninfectious sternal dehiscence and compared these patients with a control group to determine risk factors for dehiscence.


METHODS
Retrospective review of the cardiac surgery database identified 48 patients with noninfectious sternal dehiscence in a group of 12,380 median sternotomies between 1994 and 2004. The review included diagnosis, demographics, concomitant medical conditions, and surgical outcomes. Functional outcomes were assessed using the Short Form-12 questionnaire. One hundred fifty-six median sternotomy patients served as controls. Follow-up was 97.9% (47 of 48 patients) complete, for a total of 150.1 patient-years.


RESULTS
Mean age of patients at reoperation was 58.8 +/- 12.8 years, with a male to female ratio of 45:3. Multivariate analysis determined that New York Heart Association class IV, obesity, and chronic obstructive pulmonary disease were preoperative risk factors for sternal dehiscence. The incidence of sternal dehiscence was 0.39% at a mean interval between initial operation and reoperation of 5.4 months. At a mean interval of 3.9 months, 14.6% (7 of 48) of patients required additional sternal procedures. Infectious complications after reoperation occurred in 12.5% (6 of 48). Functional outcomes demonstrated that 72.2% (26 of 36) had no or mild limitation of physical activities, with 90.5% (38 of 42) reporting no or mild sternal pain at follow-up.


CONCLUSIONS
Although patients undergoing surgical correction of noninfectious sternal dehiscence fare better than those with infectious complications, optimal sternal approximation during the initial procedure and sternal precautions during convalescence should be emphasized to prevent recurrent complications.
Olbrecht
Vanessa A
VA
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4618, USA.
Barreiro
Christopher J
CJ
Bonde
Pramod N
PN
Williams
Jason A
JA
Baumgartner
William A
WA
Gott
Vincent L
VL
Conte
John V
JV
D000328:Adult; D000368:Aged; D001864:Bone Wires; D015331:Cohort Studies; D003646:Debridement; D018572:Disease-Free Survival; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome