OBJECTIVES: In cardiac surgery, once the poor healing occurs, the sustainable debridement is required to treat sternal wound infections, causing extra economic burden to providers and patients. This study aimed to assess the impact of using Symmetric to close the muscle and subcutaneous layer of median sternotomy on the reduction of debridement rate in cardiovascular surgery.

METHODS: The study was designed as a retrospective cohort study using the electric medical records collected during January 2016 to December 2017 from Beijing Anzhen Hospital Affiliated to Capital Medical University. According to the suturing techniques, patients who underwent direct heart surgery were divided into Conventional Group (continuously suturing by conventional suture) and Symmetric Group (continuously suturing by knotless suture, Symmetric). Logistic regression analysis was conducted to assess the correlation between the use of Symmetric and debridement risk.

RESULTS: A total of 1568 eligible patients out of 1747 were included in the final analysis. 39 out of 1568 patients underwent debridement surgery post operation (2.4%). The total length of stay was significantly longer for patients in which debridement occurred comparatively to other patients (30.3±19.2 vs. 13.6±6.3 days, p<0.001). Compared with Conventional Group (n=204), Symmetric Group (n=1364) showed a lower debridement rate (2.2% vs. 4.4%, p=0.058) and a significant shorter length of stay (7.6±5.2 vs. 8.5±8.8 days, p=0.050). After adjusting types of procedure, time for cardiopulmonary bypass, age and gender, the logistic regression models showed that the continuous suturing by Symmetric was the independent protective factor on debridement risk post direct heart surgery (OR 0.451, 95% CI 0.208-0.980, p=0.044).

CONCLUSIONS: Postoperative debridement could cause extremely longer length of stay. The use of Symmetric for median sternotomy closure at direct heart surgery is associated with lower risk of debridement compared with conventional suture.