TY - JOUR
T1 - Early and late outcomes with prolonged open chest management after cardiac surgery
AU - Wong, Joshua K.
AU - Joshi, Devang J.
AU - Melvin, Amber L.
AU - Aquina, Christopher T.
AU - Archibald, William J.
AU - Lidder, Alcina K.
AU - Probst, Christian P.
AU - Massey, Howard T.
AU - Hicks, George L.
AU - Knight, Peter A.
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
PY - 2017/9
Y1 - 2017/9
N2 - 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.
AB - 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.
KW - clinical outcomes
KW - delayed sternal closure
KW - long-term survival
KW - open chest management
KW - postoperative complications
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U2 - 10.1016/j.jtcvs.2017.03.143
DO - 10.1016/j.jtcvs.2017.03.143
M3 - Article
C2 - 28579263
AN - SCOPUS:85020082492
SN - 0022-5223
VL - 154
SP - 915
EP - 924
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -