Impact of Sternal Precautions on Clinical and Patient-Reported Outcomes in Patients Undergoing Cardiac Surgery via Sternotomy: A Scoping Review

PURPOSE: Patients undergoing cardiac surgery via sternotomy are typically advised to follow sternal precautions for 8 to 12 weeks post-operatively. These precautions vary across surgical centers, and current recommendations are primarily based on heterogeneous studies and expert opinion. This scoping review aimed to map the impact of upper body movement and sternal precaution strategies on clinical and patient-reported outcomes within 1 year post-operatively in adult patients undergoing cardiac surgery via sternotomy.

REVIEW METHODS: The review was reported based on the PRISMA-ScR (Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies included randomized controlled trials; nonrandomized controlled trials; quasi-experimental, prospective, and retrospective cohort studies; mixed methods studies; case studies; case-control studies; and cross-sectional studies. Studies were considered eligible if they included patients ≥18 years undergoing cardiac surgery via sternotomy and examined the relationship between sternal precautions or upper body movement strategies within 12 weeks post-operatively and any clinical or patient-reported outcomes within 1 year post-operatively. The systematic literature search was conducted in March 2025 in 6 databases.

SUMMARY: Of 16 464 unique records screened, 12 studies involving 2853 patients were included. These studies found that neither weighted upper body movement strategies nor less restrictive sternal precautions negatively affect sternal wound infections, sternal stability, pain, length of hospital stay, readmissions, or health-related quality of life. Positive improvements were found in functional status and discharge disposition in patients following a less restrictive sternal regimen. The body of evidence indicates that weighted upper body movement strategies and less restrictive sternal precautions do not negatively affect the investigated clinical or patient-reported outcomes post-sternotomy.