Trauma Sternotomy Closure: Drain Size May Matter

Abstract

Background

Sternotomy for trauma (ST) can be life-saving, but optimal chest closure techniques and their impact on outcomes remain unclear. This study examines the association between mediastinal drain size used during ST closure and patient outcomes to determine if larger bore drain placement may mitigate need for reintervention after definitive chest closure.

Methods

A retrospective review (2015-2023) of all ST patients at an ACS-verified Level 1 trauma center was conducted, excluding intraoperative deaths. The primary outcome was mediastinal reintervention, defined as redo sternotomy or percutaneous mediastinal drainage after closure. Patients were categorized based on mediastinal drain size: small bore drains (≤15 French) (SBD) vs large bore drains (>15 French) (LBD).

Results

Forty-four patients were included: 18 (41%) in the SBD group and 26 (59%) in the LBD group. The median age was 30 years, and most were male (98%). Penetrating trauma was the primary mechanism of injury, and pericardial closure techniques were similar between groups. Mediastinal reintervention for treatment or prevention of cardiac tamponade occurred more frequently in the SBD group (22% vs 4%; P = 0.07).

Conclusion

Although mediastinal reintervention following ST was rare, SBD placement was associated with a higher incidence of reintervention compared to LBD, potentially due to inadequate mediastinal drainage. While not statistically significant, these findings suggest that larger bore drains may reduce the risk of postoperative cardiac tamponade. Multicenter study is warranted to explore these findings further with a larger patient sample size.