Impact of delayed sternal closure and negative pressure therapy after complex cardiovascular surgery.

OBJECTIVE: To evaluate the safety of delayed sternal closure with negative pressure therapy in complex cardiovascular surgeries, with a focus on infectious complications, compared to primary sternal closure. METHODS: This retrospective observational study analyzed 285 adult patients undergoing complex cardiovascular surgeries between January 2019 and February 2021 at a quaternary care hospital. Patients were divided into delayed closure (N = 91) and primary closure (N = 194) groups. Propensity score matching was applied to adjust for baseline differences, resulting in 168 matched patients for outcome comparison. RESULTS: Patients from the delayed closure group more frequently required emergency surgery (37% vs. 4.6%, p < 0.001), experienced longer extracorporeal circulation times (median 140 min vs. 84 min, p < 0.001), and needed more intraoperative transfusions (98.9% vs. 68%, p < 0.001). Postoperative bleeding in the first 12 h was higher in the delayed closure group (median 500 ml vs. 250 ml, p < 0.001). Reoperation rates due to bleeding were higher in the delayed closure group in the unmatched cohort (19.8% vs. 8.8%, p = 0.014), but not in the matched cohort (p = 0.078). In-hospital mortality (13.2% vs. 7.2%, p = 0.2) and postoperative infection rates (3.6% vs. 3.3%, p > 0.9) were similar between groups. Patients who underwent delayed closure had longer ICU and hospital stays. CONCLUSION: Delayed sternal closure with negative pressure therapy appears to be a safe management strategy for high-risk patients in complex cardiovascular surgeries. Despite increased transfusions and postoperative bleeding, delayed closure with negative pressure therapy did not result in higher mortality or infection rates compared to primary sternal closure.