INCIDENCE AND RISK FACTORS FOR STERNAL WOUND DEHISCENCE AFTER OPEN HEART SURGERY

Abstract

Background: The most common type of surgery that is used during cardiac surgery is the median sternotomy, but post-operative complications such as pain, cutaneous dehiscence, instability of the sternum and the prolonged recovery time, remain significant problems.  One of the important factors towards these results is the method of closing the sternum.  Two of the most frequently used techniques are Figure-of-Eight and Simple Interrupted technique, yet there is still no consensus on the most appropriate technique that can be used to enhance patient outcomes.

Objectives: The goal of the study was to compare clinical outcomes of using Figure-of-Eight and Simple Interrupted sternal closure methods in the group of adult patients undergoing elective cardiac surgery.  Particular outcomes included assessing differences in postoperative pain, wound healing, wound stability, ambulation time, hospital stay, functional recovery and patient satisfaction as a whole.

Methodology: Prospective, comparative, and observational study design was used.  One hundred and eight out of the total 108 patients who were to be subjected to elective median sternotomy were recruited and evenly split into two categories (n=54 each): one group was exposed to the Figure-of-Eight method of sternal closure whilst another was subjected to the Simple Interrupted method. Purposive sampling which was non-probability was applied.  The data were collected in a structured way by using clinical tools. Numeric Analog Scale (NAS) of pain, ASEPSIS wound scoring system, Sternal Instability Scale (SIS) and Barthel Index of functional status were the tools.  The data were examined using descriptive statistics, Mann-Whitney U and t -tests, chi-square/Fisher exact-tests, Spearman correlations, and estimation of the effect size.

Results: Patients in Figure-of-Eight group had significantly better results in almost every parameter measured.  The post-operative average pain scores were smaller (1.81 1.47 vs. 4.76 1.48, p<0.001).  Figure of Eights had 100% of patients with satisfactory wound healing, whereas 5.6% of the Interrupted patients had satisfactory wound healing. 72.2% of the Figure of Eights patients had a SIS Grade 0 sternal stability, and 24.1% of the Interrupted patients had a SIS Grade 0 sternal stabilization. The Barthel Index scores revealed that individuals were more functional (91.78 + 4.39 vs. 75.94 + 9.09, p<0.001) and the time spent to walk was significantly less (1.5 + 0.5 days vs. 3.56 + 0.5 days, p = 0.001).  Figure-of-Eight group was shorter in hospital stay (6.00 +1.00 days compared to 7.22 +2.12 days).  The patients were also happier (9.04 ± 0.85 vs. 6.96 ± 0.89).  All these differences were significant and big in effect sizes. 

Conclusion: Figure-of-Eight sternal closure method would contribute a lot to the outcome of the operation well in terms of pain relief, wound healing, sternal stability, mobility, and patient satisfaction more than the Simple Interrupted approach.  These advantages result in faster recuperation and the number of complications reduced.