Predictive Value of Preoperative CXR and Chest CT-Based Sternal Metrics for Postoperative Sternal Wound Healing in Open Heart | ||
| The Egyptian Journal of Hospital Medicine | ||
| Article 22, Volume 101, Issue 1, October 2025, Pages 4740-4748 PDF (678.67 K) | ||
| DOI: 10.21608/ejhm.2025.456594 | ||
| Abstract | ||
| Background: Sternal wound infection (SWI) is a serious complication of open-heart surgery that affects up to 5% of cases, resulting in tripled hospital expenditures and considerable mortality. Most preoperative risk stratification models for SWI have concentrated on clinical perioperative variables, ignoring the critical role of imaging-derived data on chest wall and sternal metrics in predicting and preventing SWI. Objectives: This research sought to explore the significance of sternal measurements derived from preoperative chest imaging, as indicated by chest X-ray (CXR) and chest computed tomography (CT), in forecasting sternal wound healing results. Patients and Methods: 240 adult patients who underwent elective open-heart surgeries via a sternotomy incision at Kasr Al-Ainy and Sohag University Hospitals from January 2021 to June 2025 were included in this study. Preoperative CXR and CT images were revised for sternal thickness, width, and cortical bone density. Postoperative sternal wound healing was evaluated both clinically and through imaging, after which patients were divided into two groups based on the occurrence of SWI. Results: Impaired wound healing occurred in 32 patients (13.3%). Compared with patients with normal healing, those with impaired healing had significantly lower mean sternal thickness (12.8 ± 1.9 mm vs. 15.1 ± 2.3 mm, p < 0.001) and reduced CT-measured bone density (420 ± 65 HU vs. 520 ± 70 HU, p < 0.001). ROC analysis demonstrated that CT-based parameters had higher discriminative ability (AUC = 0.84, 95% CI: 0.77–0.91) compared with CXR-derived metrics (AUC = 0.68, 95% CI: 0.60–0.77). Conclusions: Preoperative sternal thickness and bone density obtained from chest CT scans are robust, independent indicators of poor wound healing after open-heart surgery. Integrating these imaging-based metrics into preoperative evaluations could enhance risk stratification and assist in directing customized preventive approaches. | ||
| Keywords | ||
| Sternal wound complications; Chest X-ray; Chest CT; Sternal thickness; Bone density; Open-heart surgery | ||
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