Complications after sternal reconstruction: a 16-y experience.

BACKGROUND: Unlike risk factors associated with sternotomy complications, those associated with sternal reconstruction have not been well elucidated. We sought to examine complication rates after sternal wound reconstruction and to identify perioperative risk factors associated with these complications. METHODS: We evaluated the records of 230 consecutive patients who underwent sternal reconstruction with muscle flaps after cardiac surgery. Patient demographics, clinical comorbidities, and operative procedure types were evaluated against two outcome variables-major complications and reconstructive failure. RESULTS: The mean age of our cohort was 62 y. Major complications (readmission, reoperation, or death) occurred in 76 patients (33%), including mortality rate of 3.5%. Obesity, chronic obstructive pulmonary disease, and type of reconstructive procedure correlated with an increased risk of major complications. Reconstructive failure occurred in 39 patients (17%) and was associated with female gender, obesity, previous coronary artery bypass graft procedure, and prior left internal mammary artery usage. Regression analyses demonstrated that obesity is independently associated with an increased risk of major complications and that women are at an increased risk of reconstructive failure. Reconstructions involving the rectus abdominis were correlated with an increased risk of major complications, but this difference was not significant in multiple regression analysis. CONCLUSIONS: Usual risk factors for sternal wound development after cardiac surgery include diabetes, age, obesity, tobacco use, history of stroke, bilateral left internal mammary artery harvest, and significant blood transfusion. In distinction, this study found that the risks independently associated with major complications and reconstructive failures after reconstruction of sternal wounds are limited to obesity and female gender.