P2.014: Patient and Caregiver Perception of Post-Sternotomy Mobility and Independence With Traditional vs Patient Led Sternal Precautions Following Congenital Heart Surgery

Background: Sternal precautions are meant to protect the surgical site following congenital heart surgery requiring sternotomy. Traditional Sternal Precautions (TSP) are restrictive, limiting upper extremity range of motion and load-bearing activities for 6 weeks. TSP can potentially inhibit patient independence, and may impact overall recovery. Patient-led Sternal Precautions (PSP) promote early mobility and encourage patient movement to tolerance, which may boost patient ownership of their own recovery. This study reports on perceived postoperative mobility of patients through an institutional shift from TSP to PSP.

Methods: Surveys aiming to assess patient/caregiver understanding of sternal precautions and mobility practices were disseminated in a 10-month period in 2022 and again in 2024. Caregivers of toddlers/preschool aged patients (T/Prek) 12 mo-3 years, school-aged patients (SA) between 4-12 years, and patients themselves aged 13 years and older (Teen/Adult) were included. Patients and caregivers rated physical activity and independence at two different time points: time of discharge and time of postoperative clinic appointment, using a 5-point Likert scale, multiple-choice, and open-ended questions. Patient demographics and clinical data were reviewed retrospectively. Descriptive and univariate statistics were performed.

Results: TSP surveys had 84 respondents: 22 T/PreK, 28 SA, and 34 Teens/Adults. An additional 84 participants with PSP completed surveys in 2024: 30 T/PreK, 32 SA, and 22 Teen/Adult. Patients were discharged a median of 4[IQR:4-7] days following surgery and seen in postop clinic a median of 10[IQR:8-12] days following surgery.

At discharge, increased independence with bed mobility were reported by SA (TSP 37%, PSP 61%) and Teen/Adult (TSP 68%, PSP 81%) and with dressing by SA (TSP 37%, PSP 56%) and Teen/Adult (TSP 74%, PSP 86%). Patient and caregiver understanding of sternal precautions remained consistent with both TSP and PSP. (Table 1)

SA and Teen/Adult patients with TSP reported stagnant or declining independence following discharge, but those with PSP reported continued progression of independence with bed mobility and dressing. The most notable change was seen with SA dressing from 26% with TSP to 63% with PSP reporting independence at postop clinic (p=0.027). Teen/Adult reports of feeling ready to return to school/work at the time of postop clinic also increased (TSP 26%, PSP 45%). (Table 2)

Conclusion: From our data, PSP yielded greater independence in both SA and Teen/Adult at time of discharge, which continued to improve through the time of postop clinic. Early return to independence and desired activities can positively impact patients’ return to an active lifestyle, boosting their quality of life and subsequently decreasing prevalence of secondary impairments or comorbidities. A shift towards PSP would continue to support patients on their recovery journey while maximizing function in early recovery stages.