Precautions related to midline sternotomy in cardiac surgery. A review of mechanical stress factors leading to sternal complications

European Journal of Cardiovascular Nursing

Volumn 9, Issue 2, 2010, Pages 77-84

  Brocki, Barbara C ^a   Thorup, Charlotte B ^a   Andreasen, Jan J ^a  

^a AALBORG UNIVERSITY HOSPITAL   (Denmark)

Author keywords

Activity; Cardiac surgery; Convalescence; Sternal infection; Sternal instability

Indexed keywords

ABDOMINAL WALL MUSCULATURE; BODY MASS; CHEST INFECTION; COUGHING; DISEASE PREDISPOSITION; EVIDENCE BASED MEDICINE; HEART SURGERY; HUMAN; MECHANICAL STRESS; MEDICAL LITERATURE; OBESITY; PATIENT COUNSELING; PATIENT EDUCATION; PHYSICAL ACTIVITY; POSTOPERATIVE CARE; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; SKIN HYPERTROPHY; STERNOTOMY; STRESS STRAIN RELATIONSHIP; SURGICAL INFECTION; WEIGHT BEARING; WOUND CARE; WOUND DEHISCENCE;

CARDIAC SURGICAL PROCEDURES; HUMANS; PERIOPERATIVE NURSING; POSTOPERATIVE COMPLICATIONS; STERNOTOMY; STERNUM; STRESS, MECHANICAL;

EID: 77951621359     PISSN: 14745151     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ejcnurse.2009.11.009     Document Type: Review

References (68)

1. Dunckley M., Ellard D., Quinn T., and Barlow J. Recovery after coronary artery bypass grafting: patients' and health professionals' views of the hospital experience. Eur J Cardiovasc Nurs 6 (2007) 200-207
2. Merkouris A., Apostolakis E., Pistolas D., Papagiannaki V., Diakomopoulou E., and Patiraki E. Quality of life after coronary artery bypass graft surgery in the elderly. Eur J Cardiovasc Nurs 8 1 (2009 Mar) 74-81
3. Dunckley M., Ellard D., Quinn T., and Barlow J. Coronary artery bypass grafting: patients' and health professionals' views of recovery after hospital discharge. Eur J Cardiovasc Nurs 7 (2008) 36-42
4. Losanoff J.E., Richman B.W., and Jones J.W. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg 21 (2002) 831-839
5. Toumpoulis I., Anagnostopoulos C., DeRose J., and Swistel D. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest 127 (2005) 464-471
6. Zacharia A., and Habib R.H. Factors predisposing to median sternotomy complications. Deep vs. superficial infection. Chest 110 (1996) 1173-1178
7. Ståhle E., Tammelin A., Bergström R., and Hambreus A. Sternal wound complications - incidence, microbiology and risk factors. Eur J Cardiothorac Surg 11 (1997) 1146-1153
8. Olbrecht V.A., Barreiro C.J., Bonde P.N., Williams J.A., Baumgartner W.A., Gott V.L., et al. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg 82 (2006) 902-908
9. El Oakley R.M., and Wright J.E. Postoperative mediastinitis: classification and management. Ann Thorac Surg 61 (1996) 1030-1036
10. Adams J., Cline M.J., Hubbard M., and McCullough T. A new paradigm for post-cardiac event resistance exercise guidelines. Am J Cardiol 97 (2006) 281-286
11. Basse L., Raskov H.H., Hjort Jakobsen D., Sonne E., Billesbølle P., Hendel H.W., et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89 (2002) 446-453
12. Kehlet H., and Dahl J.B. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362 (2003) 1921-1928
13. Irion G., Benefield P., Bolton R., Collins G., and Davidson K. Effects of shoulder range of motion on sternal skin stress. Acute Care Perspect 14 (2005) 13-14
14. El-Ansary D., Waddington G., and Adams R. Control of separation in sternal instability by supportive devices: a comparison of an adjustable fastening brace, compression garment, and sports tape. Arch Phys Med Rehabil 89 (2008) 1775-1781
15. Antonovsky A. Unravelling the mystery of health (1987), Jossey-Bass Publishers, London
16. Phillips BB, Sackett C, Badenoch D, Straus D, Haynes S, Dawes B. November 1998. Updated by Jeremy Howick. Oxford Centre for Evidence-based Medicine Levels of Evidence and Grades of Recommendations. March 2009. (http://www.cebm.net/index.aspx?o=1025). Assessed June 16, 2009.
17. Bray P.W., Mahoney J.L., Anastaksis D., and Yao J.K.Y. Sternotomy infections: sternal salvage and the importance of sternal stability. CJS 39 (1996) 297-301
18. Bryan A.J., Lamarra M., Angelini G.D., West R.R., and Breckenridge I.M. Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome. J R Coll Surg Edinb 37 (1992) 305-308
19. Casha A.R., Yang L., Kay P.H., Saleh M., and Cooper G.J. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothorac Surg 15 (1999) 365-369
20. Crabtree T.D., Codd J.E., Fraser V.J., Bailey M.S., Olsen M.A., and Damiano Jr. R.J. Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg 16 (2004) 53-61
21. Lucet J.C. Surgical site infection after cardiac surgery: a simplified surveillance method. Infect Control Hosp Epidemiol 27 (2006) 1393-1396
22. Robicsek F., Folkin A., Cook J., and Bathia D. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg 48 (2000) 1-8
23. Lu J.C.Y., Grayson A.D., Jha P., Srinivasan A.K., and Fabri B.M. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 23 (2003) 943-949
24. Harrington G., Russo P., Spelman D., Borrell S., Watson K., Barr W., et al. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 25 (2004) 472-476
25. Molina J.E., Saik-Leng R., and Hyland K.J. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg 78 (2004) 912-917
26. Kendall F.P., McCreary E.K., and Provance P.G. Muscles testing and function. 4th edition (1993), Williams & Wilkins, Maryland
27. Lorenz H.P., and Longaker M.T. Wounds: biology, pathology and management (2003), Stanford University Medical Care Center
28. Kakar S., and Einhorn T.A. Biology and enhancement of skeletal repair. In: Browner B.D. (Ed). Skeletal trauma. 4th ed (2008), WB Saunders Company, Philadelphia
29. McGregor W.E., Trumble D.R., and Magovern J.A. Mechanical analysis of midline sternotomy wound closure. J Thorac Cardiovasc Surg 117 (1999) 1144-1150
30. Mc Cool F.D. Global physiology and pathophysiology of cough. ACCP evidence-based clinical practice guidelines. Chest 129 (2006) 48S-53S
31. Casha A.R., Yang L., and Cooper G.J. Measurement of chest wall forces on coughing with the use of human cadavers. Thorac Cardiovasc Surg 118 (1999) 1157-1158 Letter to the editor
32. Cohen D.J., and Griffin L.V. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg 73 (2002) 563-568
33. Dasika U.K., Trumble D.R., and Magovern J.A. Lower sternal reinforcement improves the stability of sternal closure. Ann Thorac Surg 75 (2003) 1618-1621
34. Zeitani J., Penta de Peppo A., Bianco A., Nanni F., Scafuri A., Bertoldo F., et al. Performance of a novel sternal synthesis device after median and faulty sternotomy: mechanical test and early clinical experience. Ann Thorac Surg 85 (2008) 287-293
35. Meisler P. The sternum support harness for the treatment of sternotomy pain and the prevention of sternal instability. Cardiopulm Phys Ther J 11 (2000) 63-68
36. Laurikka J.O., Toivio I., and Tarkka M. Effects of a novel pneumatic vest on postoperative pain and lung function after coronary artery bypass grafting. Scand Cardiovasc J 32 (1998) 141-144
37. Milgrom L.B., Brooks J.A., Qi R., Bunnell K., Wuestfeld S., and Beckman D. Pain levels experienced with activities after cardiac surgery. Am J Crit Care 13 (2004) 116-125
38. Schwann T.A., Habib R.H., Zacharias A., Parenteau G.L., Riordan C.J., Durham S.J., et al. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 71 (2001) 521-530
39. Rockx M.A., Fox S.A., Stitt L.W., Lehnhardt K.R., McKenzie F.N., Quantz M.A., et al. Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery. Can J Surg 47 (2004) 34-38
40. Rahmanian P.B., Adams D.H., Castillo J.G., Chikwe J., Bodian C.A., and Filsoufi F. Impact of body mass index on early outcome and late survival in patients undergoing coronary artery bypass grafting or valve surgery or both. Am J Cardiol 100 (2007) 1702-1708
41. Birkmeyer N.J., Charlesworth D.C., Hernandez F., Leavitt B.J., Marrin C.A., Morton J.R., et al. Obesity and risk of adverse outcomes associated with coronary artery bypass surgery. Circulation 97 (1998) 1689-1694
42. Tyson III G.H., Rodriguez E., Elci O.C., Koutlas T.C., Chitwood Jr. W.R., Ferguson T.B., et al. Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Ann Thorac Surg 84 (2007) 3-9
43. Orhan G., Biçer Y., Aka S.A., Sargin M., Simşek S., Senay S., et al. Coronary artery bypass graft operations can be performed safely in obese patients. Eur J Cardiothorac Surg 25 (2004) 212-217
44. Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J., and Shah A. Effects of obesity and small body size on operative and long-term outcomes of coronary artery bypass surgery: a propensity-matched analysis. Ann Thorac Surg 79 (2005) 1976-1986
45. Yap C.H., Mohajeri M., and Yii M. Obesity and early complications after cardiac surgery. Med J Aust 186 (2007) 350-354
46. Dişcigil G., Ozkisacik E.A., Badak M.I., Güneş T., and Dişcigil B. Obesity and open-heart surgery in a developing country. Anadolu Kardiyol Derg 8 (2008) 22-26
47. Olsen M.A., Lock-Buckley P., Hopkins D., Polish L.B., Sundt T.M., and Fraser V.J. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 124 (2002) 136-145
48. Maurer M.S., Luchsinger J.A., Wellner R., Kukuy E., and Edwards N.M. The effect of body mass index on complications from cardiac surgery in the oldest old. J Am Geriatr Soc 50 (2002) 988-994
49. Ridderstolpe L., Gill H., Granfeldt H., Åhlfeldt H., and Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 20 (2001) 1168-1175
50. Engelman D.T., Adams D.H., Byrne J.G., Aranki S.F., Collins Jr. J.J., Couper G.S., et al. Impact of body mass index and albumin on morbidity and mortality after cardiac Surgery. J Thorac Cardiovasc Surg 118 (1999) 866-873
51. Potapov E.V., Loebe M., Anker S., Stein J., Bondy S., Nasseri B.A., et al. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. Eur Heart J 24 (2003) 1933-1941
52. Syrakas C.A., Neumaier-Prauser P., Angelis I., Kiask T., Kemkes B.M., and Gansera B. Is extreme obesity a risk factor for increased in-hospital mortality and postoperative morbidity after cardiac surgery? Results of 2251 obese patients with BMI of 30 to 50. Thorac Cardiovasc Surg 55 (2007) 491-493
53. Wigfield C.H., Lindsey J.D., Muñoz A., Chopra P.S., Edwards N.M., and Love R.B. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40. Eur J Cardiothorac Surg 29 (2006) 434-440
54. Trick W.E., Scheckler W.E., Tokars J.I., Jones K.C., Reppen M.L., Smith E.M., et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg 119 (2000) 108-114
55. Kuduvalli M., Grayson A.D., Oo A.Y., Fabri B.M., and Rashid A. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 22 (2002) 787-793
56. Iriz E., Erer D., Koksal P., Ozdogan M.E., Halit V., Sinci V., et al. Corpus sterni reinforcement improves the stability of primary sternal closure in high-risk patients. Surg Today 37 (2007) 197-201
57. Kiessling A.H., Isgro F., Weisse U., Möltner A., Saggau W., and Boldt J. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg 80 (2005) 1537-1539
58. Parker R., Adams J.L., Ogola G., McBrayer D., Hubbard J.M., McCullough T.L., et al. Current activity guidelines for CABG patients are too restrictive: comparison of the forces exerted on the median sternotomy during a cough vs. lifting activities combined with valsalva maneuver. Thorac Cardiovasc Surg 56 (2008) 190-194
59. Irion G.L., Boyte B., Ingram J., Kirchem C., and Weathers J. Sternal skin stress produced by functional upper extremity movements. Acute Care Perspect 16 3 (2007) 3-5
60. Hawthorne M.H. Gender differences in recovery after coronary surgery. Image J Nurs Sch 26 (1994) 75-80
61. Moore S.M. A comparison of women's and men's symptoms during home recovery after coronary artery bypass surgery. Heart Lung 24 (1995) 495-501
62. King K.M. Gender and short term recovery from cardiac surgery. Nur Res 49 (2000) 29-36
63. Coperland M., Senkowski C., Ulcickas M., Mendelson M., and Griepp R.B. Breast size as a risk factor for sternal wound complications following cardiac surgery. Arch Surg 129 (1994) 757-759
64. Coperland M., Senkowski C., Ergin M.A., and Lansman S. Macromastia as a factor in sternal wound dehiscence following cardiac surgery: management combining chest wall reconstruction and reduction mammoplasty. J Card Surg 7 (1992) 275-278
65. Lamm P., Gödje O.L., Lange T., and Reichart B. Reduction of wound healing problems after median sternotomy by use of retention sutures. Ann Thorac Surg 66 (1998) 2125-2126
66. King K.M., Tsuyuki R., Faris P., and Currie G. A randomized controlled trail of women's early use of a novel undergarment following sternotomy: the Women's Recovery from Sternotomy Trial (WREST). Am Heart J 152 (2006) 1187-1193
67. Naismith C., and Street A. Introducing the cardibra: a randomised pilot study of a purpose designed support bra for women having cardiac surgery. Eur J Cardiovasc Nurs (2005) 220-226
68. Irion G., Boyer S., McGinnis T., Thomason M., and Trippe A. Effect of upper extremity movement on sternal skin stress. Acute Care Perspect 15 3 (2006) 3-6