Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial.
BACKGROUND
One factor for the development of sternal wound infection (SWI) is bony instability after sternotomy. This study compares two surgical techniques with respect to the occurrence of SWI in patients with an increased risk.


METHODS
In this multicenter study, 815 consecutive patients with an increased risk for SWI were prospectively randomly assigned to a conventional osteosynthesis (transsternal or peristernal wiring; n = 440) or to an osteosynthesis with additional lateral reinforcement (Robicsek; n = 375). Primary endpoints were the rate of sternal dehiscence as well as the occurrence of superficial sternal wound infections and deep sternal wound infections.


RESULTS
Both groups were comparable concerning preoperative and intraoperative variables. The rate of sternal dehiscence, superficial sternal wound infections, and deep sternal wound infections (conventional technique 2.5%, 3.4%, 2.5%; and Robicsek 3.7%, 5.6%, 3.7%) did not differ between the groups. Logistic regression analysis found independent risk factors for the development of sternal dehiscence: body mass indes greater than 30 kg/m(2) (odds ratio [OR]: 2.9; p = 0.05), New York Heart Association class more than III (OR: 2.4; p = 0.07), impaired renal function (OR: 3.9; p = 0.01), peripheral arterial disease (OR: 3.6; p = 0.001), immunosuppressant state (OR: 3.3; p = 0.001), sternal closure performed by an assistant doctor (OR: 2.5, p = 0.004), postoperative bleeding (OR: 4.2; p = 0.03), transfusion of more than 5 red blood units (OR: 3.7, p = 0.01), reexploration for bleeding (OR: 6.9, p = 0.001), and postoperative delirium (OR: 3.5, p = 0.01). There was an inverse relation between the numbers of wires and DSWI in patients with conventional sternal closure (p = 0.008).


CONCLUSIONS
In patients with an increased risk for sternal instability and wound infection after cardiac surgery, sternal reinforcement according to the technique described by Robicsek did not reduce this complication.
Schimmer
Christoph
C
Universitätsklinik Würzburg, Klinik für Thorax-, Herz- und Thorakale Gefäbchirurgie, Würzburg, Germany.
Reents
Wilko
W
Berneder
Silvia
S
Eigel
Peter
P
Sezer
Oemer
O
Scheld
Hans
H
Sahraoui
Kerim
K
Gansera
Brigitte
B
Deppert
Oliver
O
Rubio
Alvaro
A
Feyrer
Richard
R
Sauer
Cathrin
C
Elert
Olaf
O
Leyh
Rainer
R
D000368:Aged; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control* / Q000628:therapy; D013530:Surgical Wound Infection / Q000517:prevention & control* / Q000628:therapy; D053441:Suture Anchors; D013536:Suture Techniques; D013718:Tensile Strength; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology