Retrospective analysis of the impact of sternum closure technique on postoperative comfort and rehabilitation

Introduction
Sternum closure techniques have been compared regarding biomechanics, efficacy in high-risk patients and prevention of mediastinitis or sternal dehiscence. There are no papers concerning patients’ comfort and postoperative rehabilitation rate.

Aim
To establish the best surgical closure technique after midline sternotomy regarding the lowest pain level in the postoperative period and the highest rate of postoperative rehabilitation.

Material and methods
A retrospective analysis was performed on a group of 100 patients after cardiothoracic procedures which was divided into 3 subgroups according to sternal closure technique based on postoperative thoracic X-ray. To assess patients’ pain and their physical activity we used a custom questionnaire. The statistical analysis was performed on the data regarding occurrence of wound healing complications risk factors, Numerical Rating Scale (NRS) for Pain score, the number of days until achieving important rehabilitations stages and the occurrence of sternal refixation.

Results
Subgroups had 35, 33 and 32 patients. The statistical analysis showed significantly lower NRS scores between the 14th (p = 0.0012) (1.17) and 30th (p = 0.0196) day (0.65) after the procedure in the group sutured with only single interrupted wire. There was also a significant difference in the number of days between the operation and the first time the patient could lie sideways (p = 0.0105). There was no statistically significant difference between the three groups regarding other measured factors.

Conclusions
The single wire suture provides less pain at the 14th and 30th day postoperatively measured on the NRS and ensures faster rehabilitation compared to sternal closing technique which involves placing both single and figure-of-8 sutures.