Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery
Abstract Background Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m2) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. To explore a potential solution to this problem, we examined the utility of transverse sternal plating for prim...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13019-019-0841-y |
| _version_ | 1828894719691718656 |
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| author | Joshua M. Liao Patrick Chan Lorraine Cornwell Peter I. Tsai Joseph H. Joo Faisal G. Bakaeen James D. Luketich Danny Chu |
| author_facet | Joshua M. Liao Patrick Chan Lorraine Cornwell Peter I. Tsai Joseph H. Joo Faisal G. Bakaeen James D. Luketich Danny Chu |
| author_sort | Joshua M. Liao |
| collection | DOAJ |
| description | Abstract Background Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m2) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. To explore a potential solution to this problem, we examined the utility of transverse sternal plating for primary sternal closure in morbidly obese cardiac surgical patients. Methods We retrospectively reviewed data from cardiac surgical patients who underwent single primary xiphoid transverse titanium plate reinforcement for primary sternal closure from August 2009 to July 2010 (n = 8), and we compared their outcomes with those of patients with BMI ≥35 kg/m2 who underwent cardiac surgery without sternal plate reinforcement from April 2008 to July 2009 (n = 14). All cases were performed by the same surgeon. Results The 2 groups of patients had similar demographics and comorbidities (P > 0.05 for all). All patients with sternal plate reinforcement reported sternal stability at last follow-up (at a median of 27 months postoperatively; range, 8.4–49.3 months), whereas 1 patient (7.1%) who underwent standard closure developed sterile sternal dehiscence (P = 0.4). Postoperative patient-controlled analgesia (PCA) morphine usage was significantly higher for patients without sternal plate reinforcement than for patients who had sternal plate reinforcement (3.6 mg/h vs 1.3 mg/h, P = 0.008). No patient in the sternal plate group had wound seroma or perioperative complications attributable to sternal closure technique. Conclusion Single xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage. Ultramini abstract Morbidly obese patients (body mass index ≥35 kg/m2) have a higher-than-normal risk of sternal dehiscence after cardiac surgery. In a pilot study, we found that those who underwent transverse sternal plating (n = 8) had no sternal dehiscence and required less postoperative analgesia than patients who underwent standard wire closure (n = 14). |
| first_indexed | 2024-12-13T14:16:34Z |
| format | Article |
| id | doaj.art-0c96755ae1d049efb4ba98c9e1a578a4 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-13T14:16:34Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-0c96755ae1d049efb4ba98c9e1a578a42022-12-21T23:42:17ZengBMCJournal of Cardiothoracic Surgery1749-80902019-01-011411710.1186/s13019-019-0841-yFeasibility of primary sternal plating for morbidly obese patients after cardiac surgeryJoshua M. Liao0Patrick Chan1Lorraine Cornwell2Peter I. Tsai3Joseph H. Joo4Faisal G. Bakaeen5James D. Luketich6Danny Chu7Department of Medicine, University of WashingtonDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineDepartment of Surgery, University of HawaiiDepartment of Surgery, University of HawaiiCollege of Medicine, Texas A&M UniversityDepartment of Thoracic and Cardiovascular Surgery, Cleveland ClinicDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineAbstract Background Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m2) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. To explore a potential solution to this problem, we examined the utility of transverse sternal plating for primary sternal closure in morbidly obese cardiac surgical patients. Methods We retrospectively reviewed data from cardiac surgical patients who underwent single primary xiphoid transverse titanium plate reinforcement for primary sternal closure from August 2009 to July 2010 (n = 8), and we compared their outcomes with those of patients with BMI ≥35 kg/m2 who underwent cardiac surgery without sternal plate reinforcement from April 2008 to July 2009 (n = 14). All cases were performed by the same surgeon. Results The 2 groups of patients had similar demographics and comorbidities (P > 0.05 for all). All patients with sternal plate reinforcement reported sternal stability at last follow-up (at a median of 27 months postoperatively; range, 8.4–49.3 months), whereas 1 patient (7.1%) who underwent standard closure developed sterile sternal dehiscence (P = 0.4). Postoperative patient-controlled analgesia (PCA) morphine usage was significantly higher for patients without sternal plate reinforcement than for patients who had sternal plate reinforcement (3.6 mg/h vs 1.3 mg/h, P = 0.008). No patient in the sternal plate group had wound seroma or perioperative complications attributable to sternal closure technique. Conclusion Single xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage. Ultramini abstract Morbidly obese patients (body mass index ≥35 kg/m2) have a higher-than-normal risk of sternal dehiscence after cardiac surgery. In a pilot study, we found that those who underwent transverse sternal plating (n = 8) had no sternal dehiscence and required less postoperative analgesia than patients who underwent standard wire closure (n = 14).http://link.springer.com/article/10.1186/s13019-019-0841-yObesitySternal wound dehiscenceSternal platingCardiac surgery |
| spellingShingle | Joshua M. Liao Patrick Chan Lorraine Cornwell Peter I. Tsai Joseph H. Joo Faisal G. Bakaeen James D. Luketich Danny Chu Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery Journal of Cardiothoracic Surgery Obesity Sternal wound dehiscence Sternal plating Cardiac surgery |
| title | Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery |
| title_full | Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery |
| title_fullStr | Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery |
| title_full_unstemmed | Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery |
| title_short | Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery |
| title_sort | feasibility of primary sternal plating for morbidly obese patients after cardiac surgery |
| topic | Obesity Sternal wound dehiscence Sternal plating Cardiac surgery |
| url | http://link.springer.com/article/10.1186/s13019-019-0841-y |
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