Srivastava Vivek, Yap Cheng-Hon, Burdett Clare, Smailes Tracey, Kendall Simon, Akowuah Enoch
Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
Department of Cardiothoracic Surgery, Barwon Health, Geelong, VIC, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Interact Cardiovasc Thorac Surg. 2015 Dec;21(6):699-704. doi: 10.1093/icvts/ivv238. Epub 2015 Sep 7.
Sternal stability is essential to prevent serious infective complications after sternotomy. This paper examines whether nitinol thermoreactive clips reduce sternal wound infection rates in obese patients [body mass index (BMI) ≥30] compared with sternal wires.
All patients with BMI ≥30 undergoing cardiac surgery via median sternotomy between February 2008 and February 2013 in our institution were divided into two groups depending on sternal closure technique-sternal wires or thermoreactive clips. Comparison was made using propensity-matched analysis with sternal wound infection as the primary outcome.
Of 1371 patients, 826 (60%) had thermoreactive clips and 545 (40%) sternal wires. The sternal wires group was older (mean age 66.62 ± 10.1 vs 64.35 ± 9.8 years, P = 0.00) with a greater proportion of females (39 vs 26%, P = 0.00). In unmatched group comparison, both superficial sternal wound infection (thermoreactive clips 4% vs wires 3%) and deep infection (thermoreactive clips 3% vs wires 0.6%, P = 0.00) were more common in the thermoreactive clips group. More patients in the thermoreactive clips group required debridement and a larger number had vacuum-assisted closure [thermoreactive clips 10 patients (1%) vs sternal wires 2 (0.4%)]. Propensity-matching yielded two groups of 356 patients. There was no difference in sternal wound infection rates [thermoreactive clips 19 patients (5%) vs sternal wires 15 (4%), P = 0.58] or deep sternal infection rates [thermoreactive clips 9 patients (3%) vs sternal wires 3 (1%), P = 0.11].
Thermoreactive clips did not have an advantage in the prevention of superficial or deep sternal wound infection in obese patients undergoing sternotomy.
胸骨稳定性对于预防胸骨切开术后严重感染并发症至关重要。本文探讨与胸骨钢丝相比，镍钛诺热反应夹是否能降低肥胖患者（体重指数[BMI]≥30）的胸骨伤口感染率。
2008年2月至2013年2月在我院接受正中胸骨切开术的所有BMI≥30的心脏手术患者，根据胸骨闭合技术分为两组——胸骨钢丝组或热反应夹组。以胸骨伤口感染作为主要结局，采用倾向匹配分析进行比较。
1371例患者中，826例（60%）使用热反应夹，545例（40%）使用胸骨钢丝。胸骨钢丝组患者年龄更大（平均年龄66.62±10.1岁 vs 64.35±9.8岁，P = 0.00），女性比例更高（39% vs 26%，P = 0.00）。在未匹配组比较中，热反应夹组的表浅胸骨伤口感染（热反应夹4% vs 钢丝3%）和深部感染（热反应夹3% vs 钢丝0.6%，P = 0.00）更为常见。热反应夹组更多患者需要清创，且使用负压封闭引流的患者数量更多（热反应夹10例患者[1%] vs 胸骨钢丝2例[0.4%]）。倾向匹配后得到两组各356例患者。胸骨伤口感染率[热反应夹组19例患者（5%） vs 胸骨钢丝组15例（4%），P = 0.58]或深部胸骨感染率[热反应夹组9例患者（3%） vs 胸骨钢丝组3例（1%），P = 0.11]无差异。
对于接受胸骨切开术的肥胖患者，热反应夹在预防表浅或深部胸骨伤口感染方面并无优势。
