Application of new rigid sternal plates and prediction of sternal
dehiscence in high-risk patients
Abstract
Background: Sternal dehiscence is a serious complication of
cardiac surgery that has been a clinically intractable problem. The
study aimed to explore the advantages of new rigid sternal plates (NRSP)
compared with wire cerclage (WC) in the cardiac surgery of high- risk
patients with sternal dehiscence and summarize the application
experience. Methods: A retrospective analysis was performed on
high-risk patients for sternal dehiscence who underwent cardiac surgery
operation in the Department of Cardiovascular Surgery, The First
Affiliated Hospital of Zhengzhou University from January 2017 to
December 2021. All cases were identified and divided into WC (n=276) and
NRSP (n=291). Risk factors for sternal complications, postoperative
outcomes and cost associated with surgery and subsequent treatment were
analyzed. Results: There was no significant difference in
demographics and preoperative comorbidities compared to patients with
WC(p>0.05), those with NRSP had longer sternal closure time(p<0.001).
However, there are shorter hospital length of stay(p<0.001), less
postoperative drainage volume of 24h (p<0.001), and lower total costs
at 6 months(p=0.043) and 12 months(p<0.001) in NRSP patients. After
multivariate logistic regression analysis, the remaining five
independent risk factors for the development of sternal dehiscence were
used to compose the nomogram. The area under the receiver operating
characteristic curve (AUC) of the model was 0.865 (95% confidence
interval [CI], 0.802–0.927), and the calibration curve was good by
the Hosmer–Lemeshow test. Conclusions: NRSP can enhance the
stability of sternal fixation in high-risk patients after cardiac
surgery and reduce the risk of sternal complications. Moreover, the
nomogram comprised of age, body mass index (BMI)>30kg/m
2, diabetes mellitus(DM), chronic obstructive
pulmonary disease (COPD) and sternal closure method may predict the risk
of sternal dehiscence.