Effectiveness of Sternal Precautions after Median Sternotomy: A Systematic Review

Abstract

Purpose: The purpose of this systematic review is to analyze the current scope of literature on the effectiveness of sternal precautions or specific movement restrictions to reduce risk of sternal complications following a median sternotomy. Methods: A systematic database search was completed using PubMed, MEDLINE Complete, PEDro, Scopus, and Cochrane. Each database was searched using the key words: “sternotomy”, “sternal precautions”, “sternal restrictions” AND “sternal stress”. Articles published in English between 2010 & 2014 based on the use of sternal precautions in patients’ after sternotomy as one of the primary interventions, experimental designs comparing the forces applied on the sternum, and systematic reviews were included. Articles were excluded if interventions did not include use of sternal precautions. Two articles where further identified through searching the studies cited in the current reviews. After duplicate articles were excluded, 7 articles were left for screening of the abstract for relevance on sternal precautions. Six articles satisfied the criteria for full text screening. One article was excluded due to lack of access to the full text. Results: The current evidence suggests that significant variations in the use of sternal precautions or specific movement restrictions after a median sternotomy exist. There is no consensus on the clinical definition of these precautions causing wide variation in the application of sternal precautions. To date, paucity of evidence exists in supporting the use of restrictive sternal precautions. Conclusions: The body of evidence on the use of sternal precautions is scarce. While the risk of complications and predictors of risk following a median sternotomy are thoroughly studied on a physiological level, the movement factors influencing recovery have little to no evidence. Further research is needed to investigate if these movement restrictions are necessary and if they influence outcomes, recovery, and quality of life. Clinicians must consider the patient’s unique characteristics including comorbidities, impairments, functional limitations, and prior level of activity when prescribing sternal precautions, rather than restricting functional and physical activities based on a protocol applied homogeneously to all patients after median sternotomy.