Ardigò Andrea, Francica Alessandra, Veraldi Gian Franco, Tropea Ilaria, Tonelli Filippo, Rossetti Cecilia, Onorati Francesco, Faggian Giuseppe
Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy.
Vascular Surgery Unit, University Hospital in Verona, 37126 Verona, Italy.
J Clin Med. 2021 Jan 8;10(2):207. doi: 10.3390/jcm10020207.
Sternal wound complications are serious events that occur after cardiac surgery. Few studies have investigated the predictive value of chest X-ray radiological measurements for sternal complications.
Several perioperative radiological measurements at chest X-ray and clinical characteristics were computed in 849 patients deemed at high risk for sternal dehiscence (SD) or More than Grade 1 Surgical Site Infection (MG1-SSI). Multivariable analysis identified independent predictors, whilst receiver operating characteristics (ROC) curve analyses highlighted cut-off values of radiological measurements for the prediction of both complications.
SD occurred in 8.8% of the patients, MG1-SSI in 6.8%. Chronic obstructive pulmonary disease (COPD) was the only independent predictor for SD (Odds Ratio, O.R. 12.1; < 0.001); proximal sternal height (PSH) was the only independent protective factor (O.R. 0.58; < 0.001), with a cut-off value of 11.7 mm (sensitivity 70.5%, specificity 71.0%; ROC area under the curve (AUC) = 0.768, < 0.001). Diabetes mellitus (O.R. 3.5; < 0.001) and COPD (O.R. 21.3; < 0.001) were independent predictors for MG1-SSI; indexed proximal sternal height (iPSH) was as a protective factor (O.R. 0.26; < 0.001) with a cut-off of 5.97 mm (sensitivity 70.2%, specificity 69.0%; ROC AUC = 0.739, < 0.001). No other radiological measurements were independently correlated with SD or MG1-SS ( = N.S.).
PSH and iPSH at preoperative chest X-ray may act as indicators of high risk for sternal wound complications, allowing for early preventative measures.
胸骨伤口并发症是心脏手术后发生的严重事件。很少有研究调查胸部X线放射学测量对胸骨并发症的预测价值。
对849例被认为有胸骨裂开（SD）或超过1级手术部位感染（MG1-SSI）高风险的患者进行了胸部X线的多项围手术期放射学测量和临床特征分析。多变量分析确定了独立预测因素，而受试者工作特征（ROC）曲线分析突出了用于预测两种并发症的放射学测量的临界值。
8.8%的患者发生了SD，6.8%的患者发生了MG1-SSI。慢性阻塞性肺疾病（COPD）是SD的唯一独立预测因素（比值比，OR 12.1；<0.001）；胸骨近端高度（PSH）是唯一的独立保护因素（OR 0.58；<0.001），临界值为11.7 mm（敏感性70.5%，特异性71.0%；曲线下面积（AUC）=0.768，<0.001）。糖尿病（OR 3.5；<0.001）和COPD（OR 21.3；<0.001）是MG1-SSI的独立预测因素；指数化胸骨近端高度（iPSH）是一个保护因素（OR 0.26；<0.001），临界值为5.97 mm（敏感性70.2%，特异性69.0%；ROC AUC = 0.739，<0.001）。没有其他放射学测量与SD或MG1-SS独立相关（=无显著性差异）。
术前胸部X线的PSH和iPSH可能作为胸骨伤口并发症高风险的指标，从而采取早期预防措施。
