COMPARISON OF ETHIBOND VERSUS STANDARD WIRE STERNAL CLOSURE IN ELDERLY PATIENTS

Abstract

Objective: The purpose of this study was to compare Ethibond sternal closure
versus standard wire closure in elderly age group as a determinant and risk of
mortality and morbidity in cardiac surgery in our institutional patient population.
Methodology: Between January 2006 and December 2008 information on risk
factors and mortality was collected for 800 consecutive adult patients
undergoing cardiac surgery under cardiopulmonary bypass. 128 patients above
65 years of age were retrospectively divided to those who underwent sternal
closure using either Ethibond (n=60) or standard metal wire (n=68). Follow-up
data on sternal and wound healing was assessed for up to one year post surgery
in the outpatient clinics.
Results: The following factors were associated with a higher morbidity in both
the groups: age (2%), female gender (2%), kidney function, peripheral
arteriopathy, COAD, severe neurological problems (1% each), prior cardiac
surgery, recent MI, left and right ventricular function, chronic heart failure,
elevated pulmonary pressure , acute endocarditis , symptomatic angina ( 2-4%
each) , procedure timing , seriousness of the preoperative condition, Perforated
ventricular septum, other non bypass surgery , chest surgery, each accounting
for a 1 -4 % increase in morbidity.Mortality was zero in both groups, so was the number of sternal dehiscence and deep sternal infection ( total of zero cases) during the first month of follow up post surgery. 12 patients had superficial sternal wound infection, 7 patients from group A (Ethibond) and 5 from group B (standard wire).Pain scores in both groups did not exceed 7 out of a 0 to 10 scale and the pain was relieved by Paracetamole and Codeine.
Conclusion: This study showed Ethibond sternal closure was not associated
with increased complications or patient discomfort due to sternal wound than the
standard wire closure, in the elderly age group.