Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Tran, Bao Ngoc N., Chen, Austin D., Granoff, Melisa D., Johnson, Anna Rose, Kamali, Parisa, Singhal, Dhruv, Lee, Bernard T., Fukudome, Eugene Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Plastic and Reconstructive Surgeons 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657184/
https://www.ncbi.nlm.nih.gov/pubmed/31336422
http://dx.doi.org/10.5999/aps.2018.01102
_version_ 1783438762998497280
author Tran, Bao Ngoc N.
Chen, Austin D.
Granoff, Melisa D.
Johnson, Anna Rose
Kamali, Parisa
Singhal, Dhruv
Lee, Bernard T.
Fukudome, Eugene Y.
author_facet Tran, Bao Ngoc N.
Chen, Austin D.
Granoff, Melisa D.
Johnson, Anna Rose
Kamali, Parisa
Singhal, Dhruv
Lee, Bernard T.
Fukudome, Eugene Y.
author_sort Tran, Bao Ngoc N.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6657184
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Korean Society of Plastic and Reconstructive Surgeons
record_format MEDLINE/PubMed
spelling pubmed-66571842019-07-29 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. Arch Plast Surg Original Article 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. Korean Society of Plastic and Reconstructive Surgeons 2019-07 2019-07-15 /pmc/articles/PMC6657184/ /pubmed/31336422 http://dx.doi.org/10.5999/aps.2018.01102 Text en Copyright © 2019 The Korean Society of Plastic and Reconstructive Surgeons This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Tran, Bao Ngoc N.
Chen, Austin D.
Granoff, Melisa D.
Johnson, Anna Rose
Kamali, Parisa
Singhal, Dhruv
Lee, Bernard T.
Fukudome, Eugene Y.
Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
title Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
title_full Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
title_fullStr Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
title_full_unstemmed Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
title_short Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database
title_sort surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the american college of surgeons-national surgical quality improvement program database
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657184/
https://www.ncbi.nlm.nih.gov/pubmed/31336422
http://dx.doi.org/10.5999/aps.2018.01102
work_keys_str_mv AT tranbaongocn surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT chenaustind surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT granoffmelisad surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT johnsonannarose surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT kamaliparisa surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT singhaldhruv surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT leebernardt surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase
AT fukudomeeugeney surgicaloutcomesofsternalrigidplatefixationfrom2005to2016usingtheamericancollegeofsurgeonsnationalsurgicalqualityimprovementprogramdatabase