Quality of Life Post-Sternotomy: Reassessing the Utility of Standard-of-Care Sternal Precautions

Abstract

<h3>Purpose</h3> Standard sternal precautions are prescribed for six to eight weeks following median sternotomy and include measures such as avoiding >10 lb weight lifting, overhead movements, and driving. However, postoperative complications have declined in large part due to advances in sternal closure techniques from traditional wire cerclage to sternal plating. A single published report from overseas suggested that current precautions may be unnecessarily restrictive and result in increased recovery time and reduced quality of life post sternotomy. To date, there is no published US study that investigated the psychosocial outcomes following median sternotomy. We hypothesize that reduction in sternal precautions will lead to a higher quality of life without compromising sternal integrity. <h3>Methods</h3> In this single-center, prospective 1:1 randomized study, we plan to enroll 64 patients who will undergo sternotomy for open heart surgeries (excluding heart transplant and LVAD implantation) at University of Chicago Medical Center into either standard of care or self-managed precautions groups. The former group requires strict adherence to current institutional sternal precautions, while the latter group will be guided by comfort and/or pain based on self-perceived and self-assessed physical limitations. English-speaking patients between the ages of 18-70 receiving a first-time median sternotomy are eligible for enrollment. For eight weeks post discharge, a quality of life EQ5D questionnaire will be administered weekly via telephone by a medical professional who will separately verify adherence to the assigned protocols as well as document occurrence of major adverse clinical events. <h3>Endpoints</h3> The primary objective of this study is to determine whether patients in the self-managed group can achieve increased quality of life as compared to the standard sternal precautions group following median sternotomy without increase in adverse clinical events. The findings could potentially provide strong evidence for updated and uniform sternal precautions protocols that eliminate outdated restrictions and enhance overall quality of life post sternotomy.