Prevention of Sternal Dehiscence and Infection in High-Risk Patients: A Prospective Randomized Multicenter Trial

摘要: Background One factor for the development of sternal wound infection (SWI) is bony instability after sternotomy. This study compares two surgical techniques with respect to occurrence SWI in patients an increased risk. Methods In this multicenter study, 815 consecutive risk were prospectively randomly assigned a conventional osteosynthesis (transsternal or peristernal wiring; n=440) additional lateral reinforcement (Robicsek; n=375). Primary endpoints rate dehiscence as well superficial infections and deep infections. Results Both groups comparable concerning preoperative intraoperative variables. The dehiscence, infections, (conventional technique 2.5%, 3.4%, 2.5%; Robicsek 3.7%, 5.6%, 3.7%) did not differ between groups. Logistic regression analysis found independent factors dehiscence: body mass indes greater than 30 kg/m 2 (odds ratio [OR]: 2.9; p = 0.05), New York Heart Association class more III (OR: 2.4; 0.07), impaired renal function 3.9; 0.01), peripheral arterial disease 3.6; 0.001), immunosuppressant state 3.3; closure performed by assistant doctor 2.5, 0.004), postoperative bleeding 4.2; 0.03), transfusion 5 red blood units 3.7, reexploration 6.9, delirium 3.5, 0.01). There was inverse relation numbers wires DSWI ( 0.008). Conclusions cardiac surgery, according described reduce complication.