Lower Functional Status and Sternal Precaution Noncompliance May Not Be Related to Dehiscence Post-Median Sternotomy

Abstract

The purpose of this study was to examine the relationship between functional status, compliance with sternal precautions, and aseptic osseous postoperative incision complications. Although there is limited research on upper extremity use and noncompliance with sternal precautions and sternal motion, there is a paucity of literature on functional status and noncompliance with sternal precautions and their effect on actual sternal complications, specifically aseptic osseous dehiscence. A retrospective medical record review was performed on 113 patients with an incisional complication following median sternotomy. Functional status was assessed using the AM-PAC “6-Clicks” Basic Mobility Short Form and initial gait distance. Compliance to sternal precautions was assessed using clinical documentation to determine the percentage of therapy sessions requiring cues. Propensity score matching was performed to select matched comparator records for those with aseptic osseous dehiscence. A descriptive, in-depth chart review was then performed to determine other possible clinical factors contributing to complication. Eight of 113 patients had aseptic osseous dehiscence. Initial AM-PAC “6-Clicks” score (U = 4.375, P = .036), initial gait distance (U = 7.252, P = .007), and number of ventilator days (U = 2.790, P = .005) were significantly different in the aseptic osseous group compared to other complication types. However, the number of ventilator days was the only variable that remained significant (U = 52.5, P = .028) between those with aseptic osseous dehiscence and the 8 matched comparators. The in-depth chart review revealed that the aseptic osseous group had respiratory complications in 5 of 8 records as compared with 2 of 8 records in the comparator group. The findings of this study suggest that confounding clinical factors besides functional status and compliance to sternal precautions could have contributed to aseptic osseous dehiscence following median sternotomy. Respiratory complications postoperatively may be a key confounding factor in aseptic osseous dehiscence. Therefore, the effect of functional status and noncompliance to traditional sternal precautions remains unclear.