Abstract：
Delayed sternal closure (DSC) after cardiac surgery is a temporizing measure to address coagulopathy or haemodynamic instability after cardiac surgery. We sought to study: (i) indications and temporal trends for DSC, (ii) factors associated with time to chest closure and (iii) its impact on short-term and long-term outcomes.
From January 2007 to December 2017, 494 patients (median age 67 years, 66% males) required DSC after cardiac surgery. Medical records were reviewed for indications, risk factors, time to DSC and outcomes. Multivariable Cox regression via landmark analysis of 486 5-day survivors was used to investigate the impact of time to chest closure on early and late survival.
Coagulopathy and haemodynamic instability were the most common indications. Median time to chest closure was 2 days. Pre-/intraoperative extracorporeal membranous oxygenation, severe right ventricular dysfunction and diabetes mellitus were associated with longer time to chest closure. Longer time to closure was associated with increased risk of operative complications and operative mortality, but did not have a statistically significant association with late mortality. Increasing age, pulmonary hypertension and a greater number of prior sternotomies were also found to be associated with overall mortality.
While longer time to chest closure was associated with increased rates of operative complications and operative mortality, it did not reveal a statistically significant association with long-term survival.
From January 2007 to December 2017, 494 patients (median age 67 years, 66% males) required DSC after cardiac surgery. Medical records were reviewed for indications, risk factors, time to DSC and outcomes. Multivariable Cox regression via landmark analysis of 486 5-day survivors was used to investigate the impact of time to chest closure on early and late survival.
Coagulopathy and haemodynamic instability were the most common indications. Median time to chest closure was 2 days. Pre-/intraoperative extracorporeal membranous oxygenation, severe right ventricular dysfunction and diabetes mellitus were associated with longer time to chest closure. Longer time to closure was associated with increased risk of operative complications and operative mortality, but did not have a statistically significant association with late mortality. Increasing age, pulmonary hypertension and a greater number of prior sternotomies were also found to be associated with overall mortality.
While longer time to chest closure was associated with increased rates of operative complications and operative mortality, it did not reveal a statistically significant association with long-term survival.
摘要：
目的：心脏手术后延迟胸骨闭合（DSC）是解决心脏手术后凝血障碍或血流动力学不稳定的临时措施。我们试图研究：(1)DSC的适应症和时间趋势，（2）与闭胸时间相关的因素和（3）其对短期和长期结果的影响。
方法：从2007年1月至2017年12月，494例患者（中位年龄67岁，66％的男性）在心脏手术后需要DSC。检查了医疗记录的适应症,危险因素，时间到DSC，和结果。通过对486名5天幸存者进行界标分析，使用多变量Cox回归来研究胸部闭合时间对早期和晚期生存率的影响。
结果：凝血病和血流动力学不稳定是最常见的适应症。闭合胸部的中位时间为2天。术前/术中体外膜氧合，严重的右心室功能障碍和糖尿病与胸腔闭合时间延长相关.延长闭合时间与手术并发症和手术死亡率的风险增加相关。但与晚期死亡率无统计学显著关联.年龄增长,肺动脉高压,并且发现更多的既往胸骨瘤与总死亡率相关.
结论：虽然合胸时间延长与手术并发症和手术死亡率增加相关，它没有显示与长期生存率的统计学显著关联.
方法：从2007年1月至2017年12月，494例患者（中位年龄67岁，66％的男性）在心脏手术后需要DSC。检查了医疗记录的适应症,危险因素，时间到DSC，和结果。通过对486名5天幸存者进行界标分析，使用多变量Cox回归来研究胸部闭合时间对早期和晚期生存率的影响。
结果：凝血病和血流动力学不稳定是最常见的适应症。闭合胸部的中位时间为2天。术前/术中体外膜氧合，严重的右心室功能障碍和糖尿病与胸腔闭合时间延长相关.延长闭合时间与手术并发症和手术死亡率的风险增加相关。但与晚期死亡率无统计学显著关联.年龄增长,肺动脉高压,并且发现更多的既往胸骨瘤与总死亡率相关.
结论：虽然合胸时间延长与手术并发症和手术死亡率增加相关，它没有显示与长期生存率的统计学显著关联.
