Non-infectious sternal dehiscence after coronary artery bypass surgery

Funding Information: This study was funded by the University of Iceland Research Fund, Landspitali University Hospital Research Fund, and the Memorial Fund of Helga Jonsdottir & Sigurlidi Kristjansson. Publisher Copyright: © 2022, The Author(s). © 2022. The Author(s).Introduction: Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients. Materials and methods: A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results: Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions: The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.Peer reviewe

Forty year old female with cough and chest pain

Peer reviewe

Forty year old female with cough and chest pain

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloa

Short- and long-term outcomes following surgery for primary spontaneous pneumothorax in Iceland

Publisher Copyright: © 2022 Laeknafelag Islands. All rights reserved.INNGANGUR Frumkomið sjálfsprottið loftbrjóst er algengur sjúkdómur þar sem skurðaðgerð er beitt við viðvarandi loftleka eða endurteknu loftbrjósti. Tilgangur rannsóknarinnar var að kanna árangur þessara skurðaðgerða á Íslandi á 28 ára tímabili. EFNIVIÐUR OG AÐFERÐIR Afturskyggn rannsókn á 386 sjúklingum (miðgildi aldurs 24 ár, 78% karlar) sem gengust undir 430 aðgerðir á Landspítala 1991-2018. Sjúklingaþýðinu var skipt í fjögur 7 ára tímabil og þau borin saman. Árlegt nýgengi aðgerða var reiknað og upplýsingum safnað úr sjúkraskrám um fyrra heilsufar, ábendingu, tegund aðgerðar, fylgikvilla og legutíma eftir aðgerð. Aðgerðir vegna endurtekins loftbrjósts voru skráðar og forspárþættir þeirra metnir með aðhvarfsgreiningu. NIÐURSTÖÐUR Árlegur aðgerðafjöldi á tímabilinu var 14,5 (miðgildi, bil 9-27) og lækkaði nýgengi aðgerða um 2,9% á ári (p=0,004). Tæpur helmingur (49%) sjúklinga reyktu fram að aðgerð og 77% aðgerðanna voru gerðar með brjóstholssjá. Helstu fylgikvillar eftir aðgerð voru viðvarandi loftleki (17%), lungnabólga (2%) og fleiðruholssýking (0,5%) en enginn lést innan 30 daga frá aðgerð. Tuttugu og sjö sjúklingar (6%) þurftu enduraðgerð vegna endurtekins loftbrjósts, að meðaltali 16 mánuðum frá upphaflegu aðgerðinni, þar af 24 (7%) eftir brjóstholssjáraðgerð. Aðhvarfsgreining sýndi að yngri sjúklingar voru líklegri til að gangast undir aðgerð vegna endurtekins loftbrjósts. ÁLYKTANIR Skurðaðgerð vegna frumkomins sjálfsprottins loftbrjósts er örugg meðferð og alvarlegir skammtímafylgikvillar sjaldgæfir. Líkt og erlendis greinast um 6% sjúklinga með endurtekið loftbrjóst sem krefst endurtekinnar skurðaðgerðar. Nýgengi aðgerða af óþekktum orsökum hefur lækkað en benda má á að tíðni reykinga hérlendis hefur lækkað verulega á rannsóknartímabilinu.BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common disease where surgery is indicated for persistant air leak or recurrent pneumothorax. We studied the outcomes of PSP-surgery over a 28 year period in a whole nation. MATERIALS AND METHODS: A retrospective study on 386 patients (median age 24 years, 78% males) that underwent 430 PSP surgeries at Landspitali University Hospital 1991-2018. Annual incidence of the procedure was calculated and previous medical history, indication and type of surgery, complications and length of hospital stay were registered. Patients in four 7 year periods were compared, recurrent pneumothoraces requiring reoperation (median follow-up 16 years) registered and predictors of reoperation identified with logistic regression. RESULTS: Annually 14.5 PSP surgeries (median, range 9-27) were performed; the incidence decreasing by 2.9% per year on average. Every other patient smoked and 77% of surgeries were performed with video assisted thoracocopic surgery (VATS). The most common early complications (p<30 days from surgery) were persistent airleak (17%), pneumonia (2%) and empyema (0,5%). No patient died within 30 days from surgery. Reoperation for recurrent pneumothorax was performed on 27 patients; 24 following VATS (7%), median time from the primary surgery being 16 months. Logistic regression showed that younger patients were more likely to require reoperation for recurrent pneumothorax. CONCLUSIONS: Surgical treament for PSP is safe and major early complications rare. The rate of recurrent pneumothorax requiring surgery was 6%, which is similar to other studies. For unknown reasons the incidence of PSP surgery declined, but future research has to answer if it is linked to decreased smoking in the Icelandic population.Peer reviewe