Does Elective Sternal Plating Combined with Steel Wire Reduce Sternal Complication Rates in Patients with Obesity?

Çelik, Ersin; Çora, Ahmet Rıfkı

doi:10.21470/1678-9741-2022-0089

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Brazilian Journal of Cardiovascular Surgery

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Sumário

ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 38 (3) • May-Jun 2023 • https://doi.org/10.21470/1678-9741-2022-0089 copy

Does Elective Sternal Plating Combined with Steel Wire Reduce Sternal Complication Rates in Patients with Obesity?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

In this study, sternal complication rates of sternal closures with steel wire or steel wire combined with titanium plate in patients with obesity that underwent cardiac surgery were investigated.

Methods:

The data of 316 patients that underwent cardiac surgery between May 2018 and October 2021 were analyzed retrospectively; 124 patients withbody mass index (BMI) ≥ 30 kg/m² were divided into group I, patients whose sternotomy was performed with steel wires, and group II, patients whose sternotomy was performed with steel wire combined with titanium plates.

Results:

A total of 124 patients with BMI ≥ 30 kg/m² were divided into group I (n=88 [70.9%]) and group II (n=36 [29.1%]). The rate of male patients was found to be significantly higher in group I, whereas the rate of female patients was significantly higher in group II (P<0.001). BMI values were found to be low in group I and high in group II (P<0.001). The distribution of complications was different in the BMI ≥ 35.00-39.99 kg/m² and ≥ 40 kg/m² groups (P=0.003). Development of complications was found to be higher in patients with BMI ≥ 40 kg/m². Sternal dehiscence was observed in two patients in group I, while no dehiscence was observed in group II.

Conclusion:

The lower incidence of complications and the absence of non-infectious sternal complications and sternal dehiscence in patients with BMI ≥ 35 kg/m² that underwent steel wire combined titanium plate sternal closure strengthened the idea that plate-supported sternal closure can prevent sternal complications in high-risk patients.

Keywords:
Sternotomy; Sternal Dehiscence; Sternal Closure; Titanium; Sternal Infection

	Group I	Group II	Total
	n (%)	n (%)	n (%)	P-value
Sex
Male	61 (69.3)	10 (27.8)	71 (57.3)	< 0.001^* * Significant at 0.05 level according to Chi-square test
Female	27 (30.7)	26 (72.2)	53 (42.7)
BMI (kg/m²)
≥30-34.99	72 (81.8)	16 (44.4)	88 (71.0)	< 0.001^* * Significant at 0.05 level according to Chi-square test
≥35-39.99	13 (14.8)	14 (38.9)	27 (21.8)
≥40	3 (3.4)	6 (16.7)	9 (7.3)
Type of operation
AVR	5 (5.7)	1 (2.8)	6 (4.8)	0.286
CABG	74 (84.1)	30 (83.3)	104 (83.9)
Of-pump CABG	6 (6.8)	2 (5.6)	8 (6.5)
MVR	3 (3.4)	3 (8.3)	6 (4.8)
Emergency operation
None	83 (94.3)	34 (94.4)	117 (94.4)	0.978
Yes	5 (5.7)	2 (5.6)	7 (5.6)
DM
None	44 (50.0)	3 (8.3)	47 (37.9)	< 0.001*
Yes	44 (50.0)	33 (91.7)	77 (62.1)
COPD
None	61 (69.3)	19 (52.8)	80 (64.5)	0.082
Yes	27 (30.7)	17 (47.2)	44 (35.5)
Smoker
None	77 (87.5)	33 (91.7)	110 (88.7)	0.507
Yes	11 (12.5)	3 (8.3)	14 (11.3)
Postoperative mortality
None	84 (95.5)	33 (91.7)	117 (94.4)	0.409
Yes	4 (4.5)	3 (8.3)	7 (5.6)
Sternal complication
None	80 (90.9)	32 (88.9)	112 (90.3)	0.517
Non-infectious sternal wound complication	4 (4.5)	2 (5.6)	6 (4.8)
Sternal dehiscence	3 (3.4)	0	3 (2.4)
Deep sternal infection	1 (1.1)	2 (5.6)	3 (2.4)

	Group I	Group II	Total
	Median; Q1-Q3			P-value
Age, years	63; 55-69	64; 59-70	63; 56-69	0,343
BMI, kg/m²	32;30.5-34.3	35; 32.8-38.7	33; 30.8-35.7	< 0.001^* * Significant at 0.05 level according to Mann-Whitney U test
EuroSCORE	1.35; 0.83-2.10	2.03; 1.33-2.63	1.46; 1.00-2.35	0.003^* * Significant at 0.05 level according to Mann-Whitney U test
EF	57; 50-65	55; 45-63.7	55; 48.5-65	0.511
Hematocrit, %	39.3; 35.8-43.7	37.1; 33.7-41.3	38.5; 35.2-43.4	0.028^* * Significant at 0.05 level according to Mann-Whitney U test
CPB time, min	119; 98-142	117; 93-146	119; 56-142	0.920
ES, n	1; 1-2	2; 1-2.75	1; 1-2	0.065
FFP, n	1; 1-2	1; 1-2	1; 1-2	0.806
Ventilation time, h	4; 4-6	5; 4-7.25	5; 4-6	0.139
ICU time, days	3; 2-4	3; 2-3.75	3; 2-4	0.912
Hospitalization time, days	8; 7-10	8; 7-11	8; 7-10	0.858

	Beta	P-value	OR	95% CI
BMI	0.165	0.027^* * Significant at the 0.05 level according to the two-category logistic regression analysis	1.180	1.019-1.366
Sex (female)	1.476	0.003^* * Significant at the 0.05 level according to the two-category logistic regression analysis	4.366	1.680-11.363
DM	1.992	0.003^* * Significant at the 0.05 level according to the two-category logistic regression analysis	7.352	1.937-27.777
EuroSCORE	0.077	0.782	1.080	0.236-5.216
Hematocrit	0.014	0.907	1.010	0.147-6.108

BMI	≥ 35-39.99 kg/m²	≥ 40 kg/m²	Total
	n (%)	n (%)	n (%)	P-value
Sternal complication
None	24 (89.9)+	5 (55.6)+	29 (80.6)	0.003*
Non-infectious sternal wound complication	2 (7.4)	0	2 (5.6)
Sternal dehiscence	1 (3.7)	1 (11.1)	2 (5.6)
Deep sternal infection	0++	3 (33.3)++
Group I	n (%)	n (%)	n (%)	P-value
Sternal complication
None	10 (76.9)	1 (33.3)	11 (68.8)	0.028^* * Significant at P<0.05 level according to chi-square analysis
Non-infectious sternal wound complication	2 (15.4)	0	2 (12.5)
Sternal dehiscence	1 (7.7)	1 (33.3)	2 (12.5)
Deep sternal infection	0+	1 (33.3)++	1 (6.3)
Group II	n (%)	n (%)	n (%)	P-value
Sternal complication
None	14 (100)+	4 (66.7)+	18 (90)	0.026^* * Significant at P<0.05 level according to chi-square analysis
Deep sternal infection	0++	2 (33.3)++	2 (10)

	Group I	Group II	Total
Sternal complication	n (%)	n (%)	n (%)	P-value
None	11 (68.8)	18 (90.0)	29 (80.6)	0.404^* * Significant at the P<0.05 level according to the chi-square analysis
Non-infectious sternal wound complication	2 (12.5)	0	2 (5.6)
Sternal dehiscence	2 (12.5)	0	2 (5.6)
Deep sternal infection	1 (6.3)	2 (10)	3 (8.3)

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[1] Correspondence Address: Ersin Çelik https://orcid.org/0000-0002-0015-3280 Department of Cardiovascular Surgery, Isparta City Hospital, Sanayi Mahallesi Atatük Bulvarı, No: 51, Isparta, Turkey Zip Code: 32200 E-mail: dr.ersincelik@gmail.com