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DOI: 10.1055/s-0032-1332489
Prevention of sternal complications after cardiac surgery with the Posthorax® support vest: Performance and patient compliance in clinical „real life“
Aims: Recent literature suggests the Posthorax® support vest to be an effective tool to prevent sternal complications (SC) after cardiac surgery. No data exist regarding the use oft the vest outside clinical studies. Due to economic aspects it remains unclear whether the widespread use of a support vest seems reasonable. Aim of our study was to detemine the clinical outcome (SC), patient compliance and assessment of value in clinical „real life“.
Methods: We employed the support vest exclusively in patients with a high risk for sternal complications, fulfilling ≥2 of the following criteria: bilateral internal thoracic artery harvesting, diabetes mellitus, severe obesity, severe coughing, postoperative desorientation. We developped a questionnaire (15 questions), adhering to issues relevant for SC and secondary for judging how the support vest is handled after discharge. Patients were interviewed by telephone following rehabilitation stay.
Results: From 11/2011 until 07/2012 a total of 50 patients received sternal support by the Posthorax® vest. Mean age was 72 ± 6 years. 50/50 patients were followed for SC, 40/50 patients were eligible for a telephone interview. 4/50 patients (8%) developped sternal complications (2/50 (4%) superficial, 2/50 (4%) deep sternal wound infections). In 2 patients SC occured in-hospital, in 2 patients during rehabilitation. The most striking results of our interviews were: a) only 20/40 (50%) patients used the vest for a mean of 4.3 ± 2.2 weeks (continuously 16/40 (40%) patients), b) 3/4 of the patients with SC used the support for only 1 – 2 weeks, 1/4 patient not at all, c) 11/25 (44%) patients felt comfortable wearing the vest and d) 15/22 (68%) rated the vest to be valuable. Surprisingly 2 rehabilitation institutions completely declined the use of the vest.
Conclusions: Prevention of sternal complications with the Posthorax® support vest after cardiac surgery could not be proofed in clinical „real life“. Interviews with our high-risk group for wound complications detected possible reasons to be low patient compliance and less than expected appraisal of a supporting vest. Patients and covering physicians perception of the possible beneficial effects should be intensified when using the vest.