Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database

Tran, Bao Ngoc N.; Chen, Austin D.; Granoff, Melisa D.; Johnson, Anna Rose; Kamali, Parisa; Singhal, Dhruv; Lee, Bernard T.; Fukudome, Eugene Y.

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자료유형: 학술저널

저자정보: Tran, Bao Ngoc N. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Chen, Austin D. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Granoff, Melisa D. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Johnson, Anna Rose (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Kamali, Parisa (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Singhal, Dhruv (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Lee, Bernard T. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) Fukudome, Eugene Y. (Division of Plastic and Reconstructive Surgery, Department of)

저널정보: 대한성형외과학회 Archives of plastic surgery : APS Archives of plastic surgery : APS 제46권 제4호

발행연도: 2019.1

수록면: 336 - 343 (8page)

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Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

#Bone plates #Sternum #Surgery #Treatment outcome #Wound healing

참고문헌 (22)

참고문헌 신청

Mayba II / 1985 / Non-union of fractures of the sternum / J Bone Joint Surg Am 67:1091~1093

El Oakley RM / 1996 / Postoperative mediastinitis : classification and management / Ann Thorac Surg 61:1030~1036

Song DH / 2004 / Primary sternal plating in high-risk patients prevents mediastinitis / Eur J Cardiothorac Surg 26:367~372

Gummert JF / 2002 / Mediastinitis and cardiac surgery : an updated risk factor analysis in 10, 373 consecutive adult patients / Thorac Cardiovasc Surg 50:87~91

Wu LC / 2005 / Sternal nonunion : a review of current treatments and a new method of rigid fixation / Ann Plast Surg 54:55~58

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