B. Slatnick Truche1, 2, 4, P. Truche3, 4, A. Maselli1, S. Baron1, C. Kang1, D. Delvalle1, S. J. Lin1, B. T. Lee1, D. Morris1, L. Chu1, R. P. Cauley1 1Beth Israel Deaconess Medical Center, Division Of Plastic And Reconstructive Surgery, Boston, MA, USA 2Boston Children’s Hospitsl, Department Of Surgery, Boston, MA, USA 3Harvard School Of Medicine, Program In Global Surgery And Social Change, Brookline, MA, USA 4Rutgers, Robert Wood Johnson, Department Of Surgery, New Brunswick, NJ, USA
Introduction: Severe deep sternal wound (DSW) complications following cardiac surgery are a source of morbidity and mortality and often require operative debridement. We aim to develop and validate a clinical risk score for predicting risk of deep sternal wound dehiscence requiring operative debridement and introduce a prophylactic treatment algorithm to guide management of high-risk patients.
Methods: A retrospective review was conducted of patients who underwent open cardiac surgery at a single institution between October 2007 and March 2019. Potential risk factors were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and significant covariates were included in a logistic regression prediction model. Interval validation was performed using 10-fold cross-validation. A novel sternal wound dehiscence risk score was derived from the relative parameterization estimates.
Results: 134/8403 patients (1.6%) were identified as having a DSW. Female gender (OR, 2.75; 95% CI, 2.58 – 2.93), body-mass-index (OR,1.0946; 95% CI, 1.09 – 1.09), HbA1c (OR, 1.31; 95% CI, 1.28 – 1.33), peripheral vascular disease (OR, 2.38; 95% CI, 2.2005 – 2.5752), smoking (OR, 1.66; 95% CI, 1.53 – 1.79) and elevated creatinine (OR, 1.20; 95% CI, 1.18 – 1.22) were independent predictors of DSW. Patients were categorized as minimal-risk (0% to 1%), low-risk, (2% to 3%), intermediate-risk (4% to 7%), and high-risk (9% to 64.0%) based on risk score (Figure 1).
Conclusion: Risk factors for the development of deep sternal wound dehiscence following median sternotomy include female gender, elevated HbA1c, obesity, peripheral vascular disease, and tobacco use. The use of the novel sternal dehiscence risk score may help to identify patients who are at high-risk of DSW. Given that many of these identified risk factors are not modifiable in practice, this risk stratification model for DSW requiring operative debridement may provide individualized estimates of risk and guide prophylactic preventative intervention.
