The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections
Abstract Background Deep sternal wound infection (DSWI) is a rare, yet devastating complication after cardiac surgery. While the surgical treatment always implies the soft tissue and bone debridement, there is little data about this procedure. The aim of our study was to evaluate the impact of the r...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02491-7 |
| _version_ | 1797276352472154112 |
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| author | Olimpiu Bota Feras Taqatqeh Florian Bönke Maxime Mülhausen Klaus Matschke Adrian Dragu Kevin Bienger Stefan Rasche |
| author_facet | Olimpiu Bota Feras Taqatqeh Florian Bönke Maxime Mülhausen Klaus Matschke Adrian Dragu Kevin Bienger Stefan Rasche |
| author_sort | Olimpiu Bota |
| collection | DOAJ |
| description | Abstract Background Deep sternal wound infection (DSWI) is a rare, yet devastating complication after cardiac surgery. While the surgical treatment always implies the soft tissue and bone debridement, there is little data about this procedure. The aim of our study was to evaluate the impact of the radical sternectomy on the outcome in patients with DSWI and to identify the risk factors which could influence the result. The surgical techniques of piecemeal sternectomy and the newly developed en bloc sternectomy were also evaluated. Methods The study was developed as a retrospective cohort study. 86 patients with DSWI who received a radical sternal resection at our institution between March 2018 and December 2021 were included. Results The average age of the cohort was 67.3 ± 7.4 years, and 23.3% of patients were female. The average length of stay trended shorter after en bloc sternectomy (median 26 days) compared to piecemeal sternectomy (37 days). There were no significant differences between the piecemeal and en bloc sternal resection techniques. Anticoagulant and antiplatelet drugs had no significant influence on bleeding and transfusion rates. Obese patients showed an increased risk for postoperative bleeding requiring reintervention. Transfusion of packed red blood cells was significantly associated with lower hemoglobin values before surgery and ASA Class 4 compared to ASA Class 3. The in-hospital mortality was 9.3%, with female sex and reintervention for bleeding as significant risk factors. Nine patients developed an infection relapse as a chronic fistula at the level of clavicula or ribs, with ASA Class 4 as a risk factor. Conclusion Radical sternectomy is a safe procedure to treat DSWI with compromised sternal bone. Both piecemeal and en bloc techniques ensure reliable results, while complications and mortality appear to be patient-related. |
| first_indexed | 2024-03-07T15:26:05Z |
| format | Article |
| id | doaj.art-b752c9c8c29949e499297eb572152a0f |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-07T15:26:05Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-b752c9c8c29949e499297eb572152a0f2024-03-05T16:42:50ZengBMCJournal of Cardiothoracic Surgery1749-80902024-01-0119111010.1186/s13019-024-02491-7The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infectionsOlimpiu Bota0Feras Taqatqeh1Florian Bönke2Maxime Mülhausen3Klaus Matschke4Adrian Dragu5Kevin Bienger6Stefan Rasche7Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic SurgeryFaculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic SurgeryFaculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic SurgeryFaculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic SurgeryDepartment of Cardiac Surgery, University Heart Center DresdenFaculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic SurgeryFaculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic SurgerySurgical Intensive Care Unit, Faculty of Medicine Carl Gustav CarusAbstract Background Deep sternal wound infection (DSWI) is a rare, yet devastating complication after cardiac surgery. While the surgical treatment always implies the soft tissue and bone debridement, there is little data about this procedure. The aim of our study was to evaluate the impact of the radical sternectomy on the outcome in patients with DSWI and to identify the risk factors which could influence the result. The surgical techniques of piecemeal sternectomy and the newly developed en bloc sternectomy were also evaluated. Methods The study was developed as a retrospective cohort study. 86 patients with DSWI who received a radical sternal resection at our institution between March 2018 and December 2021 were included. Results The average age of the cohort was 67.3 ± 7.4 years, and 23.3% of patients were female. The average length of stay trended shorter after en bloc sternectomy (median 26 days) compared to piecemeal sternectomy (37 days). There were no significant differences between the piecemeal and en bloc sternal resection techniques. Anticoagulant and antiplatelet drugs had no significant influence on bleeding and transfusion rates. Obese patients showed an increased risk for postoperative bleeding requiring reintervention. Transfusion of packed red blood cells was significantly associated with lower hemoglobin values before surgery and ASA Class 4 compared to ASA Class 3. The in-hospital mortality was 9.3%, with female sex and reintervention for bleeding as significant risk factors. Nine patients developed an infection relapse as a chronic fistula at the level of clavicula or ribs, with ASA Class 4 as a risk factor. Conclusion Radical sternectomy is a safe procedure to treat DSWI with compromised sternal bone. Both piecemeal and en bloc techniques ensure reliable results, while complications and mortality appear to be patient-related.https://doi.org/10.1186/s13019-024-02491-7Deep sternal wound infectionRadical sternectomySternal reconstructionCardiac surgery |
| spellingShingle | Olimpiu Bota Feras Taqatqeh Florian Bönke Maxime Mülhausen Klaus Matschke Adrian Dragu Kevin Bienger Stefan Rasche The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections Journal of Cardiothoracic Surgery Deep sternal wound infection Radical sternectomy Sternal reconstruction Cardiac surgery |
| title | The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections |
| title_full | The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections |
| title_fullStr | The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections |
| title_full_unstemmed | The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections |
| title_short | The impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections |
| title_sort | impact of two radical sternectomy surgical techniques on the outcome of deep sternal wound infections |
| topic | Deep sternal wound infection Radical sternectomy Sternal reconstruction Cardiac surgery |
| url | https://doi.org/10.1186/s13019-024-02491-7 |
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