Risk factors and clinical implications of sternal dehiscence following clamshell incision in bilateral lung transplantation.
4 affiliations
- 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
- 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- 4Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Abstract
Clamshell incisions provide excellent exposure for bilateral lung transplantation (BLT) but carry an inherent risk of sternal dehiscence. This study aimed to identify the risk factors for sternal dehiscence and evaluate its impact on pulmonary function. We retrospectively analyzed 129 adult patients who underwent BLT via clamshell incision between 2007 and 2024. Sternal dehiscence was defined as radiographic nonunion of the sternum confirmed by chest computed tomography scan at least 3 months postoperatively, or any sternal dehiscence requiring surgical correction regardless of the time interval. Risk factors were identified using Firth's penalized likelihood logistic regression analysis. Pulmonary function tests were compared between patients with and without dehiscence at 1 year postoperatively and the last follow-up. Sternal dehiscence occurred in 15 patients (11.6%), of which 11 (8.5%) were classified as major cases. Multivariable analysis identified male sex as an independent risk factor associated with dehiscence [odds ratio (OR) 8.89, 95% confidence interval (CI): 1.27-108.74, P=0.02], whereas perioperative tracheostomy was independently associated with a lower incidence (OR =0.12, 95% CI: 0.02-0.53, P=0.004). Surgical closure techniques, including wiring and parasternal fixation, were not significantly associated with dehiscence (P=0.73 and P>0.99, respectively). No significant differences in pulmonary function were observed between groups at 1 year postoperatively and last follow-up. Male sex was independently associated with sternal dehiscence following BLT, whereas perioperative tracheostomy was associated with a lower incidence; these findings should be regarded as hypothesis-generating given the observational design. Pulmonary function during the follow-up period was not significantly associated with sternal dehiscence in this cohort. Surgeons may consider reinforced closure in male patients, while the protective role of tracheostomy warrants further study.
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BibTeX
@article{kim2026risk,
title = {{Risk factors and clinical implications of sternal dehiscence following clamshell incision in bilateral lung transplantation.}},
author = {Dae Hyeon Kim and Samina Park and Jimyung Park and Sun Mi Choi and Seon Yong Bae and Taeyoung Yun and Ji Hyeon Park and Bubse Na and Kwon Joong Na and Hyun Joo Lee and In Kyu Park and Chang Hyun Kang and Young Tae Kim},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-2081},
url = {https://europepmc.org/article/MED/42996940},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Risk factors and clinical implications of sternal dehiscence following clamshell incision in bilateral lung transplantation.
AU - Dae Hyeon Kim
AU - Samina Park
AU - Jimyung Park
AU - Sun Mi Choi
AU - Seon Yong Bae
AU - Taeyoung Yun
AU - Ji Hyeon Park
AU - Bubse Na
AU - Kwon Joong Na
AU - Hyun Joo Lee
AU - In Kyu Park
AU - Chang Hyun Kang
AU - Young Tae Kim
PY - 2026
DA - 2026/09/29
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-2081
UR - https://europepmc.org/article/MED/42996940
AB - Clamshell incisions provide excellent exposure for bilateral lung transplantation (BLT) but carry an inherent risk of sternal dehiscence. This study aimed to identify the risk factors for sternal dehiscence and evaluate its impact on pulmonary function. We retrospectively analyzed 129 adult patients who underwent BLT via clamshell incision between 2007 and 2024. Sternal dehiscence was defined as radiographic nonunion of the sternum confirmed by chest computed tomography scan at least 3 months postoperatively, or any sternal dehiscence requiring surgical correction regardless of the time interval. Risk factors were identified using Firth's penalized likelihood logistic regression analysis. Pulmonary function tests were compared between patients with and without dehiscence at 1 year postoperatively and the last follow-up. Sternal dehiscence occurred in 15 patients (11.6%), of which 11 (8.5%) were classified as major cases. Multivariable analysis identified male sex as an independent risk factor associated with dehiscence [odds ratio (OR) 8.89, 95% confidence interval (CI): 1.27-108.74, P=0.02], whereas perioperative tracheostomy was independently associated with a lower incidence (OR =0.12, 95% CI: 0.02-0.53, P=0.004). Surgical closure techniques, including wiring and parasternal fixation, were not significantly associated with dehiscence (P=0.73 and P>0.99, respectively). No significant differences in pulmonary function were observed between groups at 1 year postoperatively and last follow-up. Male sex was independently associated with sternal dehiscence following BLT, whereas perioperative tracheostomy was associated with a lower incidence; these findings should be regarded as hypothesis-generating given the observational design. Pulmonary function during the follow-up period was not significantly associated with sternal dehiscence in this cohort. Surgeons may consider reinforced closure in male patients, while the protective role of tracheostomy warrants further study.
SN - 2072-1439
SN - 2077-6624
ER -