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Journal of Cardiothoracic Surgery

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Open Access 01-12-2021 | Heart Surgery | Research article

Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery

Authors: Ehab Nooh, Colin Griesbach, Johannes Rösch, Michael Weyand, Frank Harig

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Background

After sternotomy, the spectrum for sternal osteosynthesis comprises standard wiring and more complex techniques, like titanium plating. The aim of this study is to develop a predictive risk score that evaluates the risk of sternum instability individually. The surgeon may then choose an appropriate sternal osteosynthesis technique that is risk- adjusted as well as cost-effective.

Methods

Data from 7.173 patients operated via sternotomy for all cardiovascular indications from 2008 until 2017 were retrospectively analyzed. Sternal dehiscence occurred in 2.5% of patients (n = 176). A multivariable analysis model examined pre- and intraoperative factors. A multivariable logistic regression model and a backward elimination based on the Akaike Information Criterion (AIC) a logistic model were selected.

Results

The model showed good sensitivity and specificity (area under the receiver-operating characteristic curve, AUC: 0.76) and several predictors of sternal instability could be evaluated. Multivariable logistic regression showed the highest Odds Ratios (OR) for reexploration (OR 6.6, confidence interval, CI [4.5–9.5], p < 0.001), obesity (body mass index, BMI > 35 kg/m²) (OR 4.23, [CI 2.4–7.3], p < 0.001), insulin-dependent diabetes mellitus (IDDM) (OR 2.2, CI [1.5–3.2], p = 0.01), smoking (OR 2.03, [CI 1.3–3.08], p = 0.001). After weighting the probability of sternum dehiscence with each factor, a risk score model was proposed scaling from − 1 to 5 points. This resulted in a risk score ranging up to 18 points, with an estimated risk for sternum complication up to 74%.

Conclusions

A weighted scoring system based on individual risk factors was specifically created to predict sternal dehiscence. High-scoring patients should receive additive closure techniques.

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Title: Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery
Authors: Ehab Nooh
Colin Griesbach
Johannes Rösch
Michael Weyand
Frank Harig
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Heart Surgery
Heart Surgery
Sternotomy
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01555-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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