Sternal closure techniques and postoperative sternal wound complications in elderly patients

Objective: Postoperative sternal wound complications (PSWC) including deep sternal wound infection (DSWI) and sternal dehiscence (SD) cause significant morbidity and mortality. Elderly patients with several risk factors are particularly prone to suffer PSWC. Methods: We present (I) a subset of 86 patients, all aged ≥75 years out of 339 cardiac surgery patients prospectively randomised to receive either conventional sternal closure or a Robicsek type closure. Primary end-points were SD and DSWI; secondary end-points included a composite of clinical parameters; (II) we retrospectively assessed data of 54/5273 patients with mediastinitis regarding the influence of advanced age. In addition, we report an epidemiological overview of different sternal closure techniques. Results: (I) The Robicsek technique showed an impact on SD and DSWI, and several secondary end-points: ventilator support (p = 0.03), postoperative blood loss (p = 0.04), and chest pain >3 days (p = 0.04). (II) A total of 54/5273 (1.02%) patients developed postoperative mediastinitis. Twelve out of 54 (22%) patients died within 6 months of the initial operation. Predictors of mortality were insulin-dependent diabetes mellitus (p = 0.05), renal insufficiency (p = 0.01), delayed sternal closure (p = 0.05), ICU-stay >10 days (p = 0.01), and methicillin-resistant Staphylococcus aureus (p = 0.03) or fungal infection (p = 0.02). Conclusions: No statistical difference in sternal dehiscence or mediastinitis was found irrespective of whether the bilateral and longitudinal parasternal closure or the conventional peri/trans-sternal wiring technique was used, but there was an obvious, positive influence on sternal dehiscence, deep sternal wound infection, and clinical parameters. However, the study population is relatively small.