Risk factors and clinical implications of sternal dehiscence following clamshell incision in bilateral lung transplantation
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Source: Journal of Thoracic Disease
Institutions: Seoul National University, Seoul National University Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224112200