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.