Early and late outcomes with prolonged open chest management after cardiac surgery

Joshua K. Wong, Devang J. Joshi, Amber L. Melvin, Christopher T. Aquina, William J. Archibald, Alcina K. Lidder, Christian P. Probst, Howard T. Massey, George L. Hicks, Peter A. Knight

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objectives Open chest management (OCM) is an important intervention for patients who are unable to undergo sternal closure after cardiac surgery. This study reviews the factors associated with a prolonged need for this intervention and investigates its association with early and late mortality. Methods Patients undergoing OCM from January 2009 to December 2014 were reviewed. Differences in the median duration of OCM when a perioperative variable was present versus its absence were determined and variables significant at P ≤.1 were analyzed using Poisson regression for factors associated with prolonged OCM. Multivariable logistic regression and Cox proportional hazards models were developed to investigate perioperative factors that were associated with early and late mortality. Results A total of 201 patients (5%) required OCM and the overall median duration of this intervention was 3 days. The use a temporary assist device (median, 7 vs 2 days; P <.001), pneumonias (median, 11 vs 3 days; P <.001), sternal re-explorations (median, 6 vs 2 days; P <.001), and renal failure (median, 6 vs 3 days; P =.02) were among the factors that were highly associated with prolonged OCM using Poisson regression. Thirty-day mortalities occurred in 32 patients (16%) and were significantly associated with emergency surgery (P =.03), sternal re-explorations (P =.001), and OCM duration (median, 6 vs 3 days; P =.02). On multivariable logistic regression and Cox analysis, delaying sternal closure by 1-day increments increased the risk of early and late mortality by 11% (P =.01), and 9% (P <.001), respectively. Conclusions Prolonged OCM was associated with increasing perioperative morbidity and a higher risk of early and late mortality.

Original languageEnglish (US)
Pages (from-to)915-924
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number3
DOIs
StatePublished - Sep 2017

Bibliographical note

Publisher Copyright:
© 2017 The American Association for Thoracic Surgery

Keywords

  • clinical outcomes
  • delayed sternal closure
  • long-term survival
  • open chest management
  • postoperative complications

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