Sternal wound reconstruction in geriatric patients: A comparison of patient characteristics and outcomes over thirty years.

Abstract

Sternal wound (SW) complications after median sternotomy remain a major source of morbidity and mortality. Large-scale, single-surgeon outcome data remain limited, especially in older patient populations. Given their comorbidity burden, geriatric patients may be at elevated risk. We analyzed an older cohort of patients who underwent sternal reconstruction to evaluate the safety and reliability of bilateral pectoralis major flap reconstruction across age groups. A retrospective review of 640 patients who underwent SW reconstruction at our institution by the senior author (J.A.A.) from 1995 to 2024 was conducted. Patient demographic variables and surgical characteristics were recorded. Subgroup analyses compared patients ≥75 years old with their younger counterparts. The overall cohort had a mean age of 64.1 years; 64.7% were men. Geriatric patients had higher rates of hypertension (77.6% vs. 66.9%, p=0.02), cancer (17.6% vs. 10.0%, p=0.019), valve disease (20.8% vs. 13.3%, p=0.037), and were more likely to undergo coronary artery bypass grafting (77.6% vs. 64.1%, p=0.0043) and aortic valve replacement (37.6% vs. 14.4%, p<0.001). Reconstruction was predominantly performed with bilateral pectoralis flaps alone (>96% in both groups). Postoperative complication rates-including soft tissue dehiscence (12.0% vs. 7.6%), infectious signs (9.6% vs. 10.7%), and seroma (7.2% vs. 4.4%)-and 30-day mortality (5.6% vs. 7.2%) were comparable between the groups. Despite greater comorbidity burdens, geriatric patients undergoing SW reconstruction demonstrated complication rates, reoperation rates, and short-term mortality comparable to younger patients. This surgical approach thus remains an effective, safe, and reliable reconstructive strategy regardless of advanced patient age, supporting its use in geriatric patients with complex clinical histories.