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Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac Surgery: A Meta-Analysis
- Source :
- The Annals of Thoracic Surgery. 106:298-304
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Traditionally, wire cerclage has been used to reapproximate the sternum after sternotomy. Recent evidence suggests that rigid plate fixation for sternal closure may reduce the risk of sternal complications. Methods The Medline and Embase databases were searched from inception to February 2017 for studies that compared rigid plate fixation with wire cerclage for cardiac surgery patients undergoing sternotomy. Random effects meta-analysis compared rates of sternal complications (primary outcome, defined as deep or superficial sternal wound infection, or sternal instability), early mortality, and length of stay (secondary outcomes). Results Three randomized controlled trials (n = 427) and five unadjusted observational studies (n = 1,025) met inclusion criteria. There was no significant difference in sternal complications with rigid plate fixation at a median of 6 months' follow-up (incidence rate ratio 0.51, 95% confidence interval [CI]: 0.20 to 1.29, p = 0.15) overall, but a decrease when including only patients at high risk for sternal complications (incidence rate ratio 0.23, 95% CI: 0.06 to 0.89, p = 0.03; two observational studies). Perioperative mortality was reduced favoring rigid plate fixation (relative risk 0.40, 95% CI: 0.28 to 0.97, p = 0.04; four observational studies and one randomized controlled trial). Length of stay was similar overall (mean difference −0.77 days, 95% CI: −1.65 to +0.12, p = 0.09), but significantly reduced with rigid plate fixation in the observational studies (mean difference −1.34 days, 95% CI: −2.05 to −0.63, p = 0.0002). Conclusions This meta-analysis, driven by the results of unmatched observational studies, suggests that rigid plate fixation may lead to reduced sternal complications in patients at high risk for such events, improved perioperative survival, and decreased hospital length of stay. More randomized controlled trials are required to confirm the potential benefits of rigid plate fixation for primary sternotomy closure.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
030204 cardiovascular system & hematology
Rate ratio
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Surgical Wound Dehiscence
medicine
Humans
Surgical Wound Infection
030212 general & internal medicine
Cardiac Surgical Procedures
Lead (electronics)
Wound Healing
Wound Closure Techniques
business.industry
Perioperative
Sternotomy
Confidence interval
Surgery
Cardiac surgery
Treatment Outcome
Relative risk
Female
Observational study
Cardiology and Cardiovascular Medicine
business
Bone Plates
Bone Wires
Subjects
Details
- ISSN :
- 00034975
- Volume :
- 106
- Database :
- OpenAIRE
- Journal :
- The Annals of Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....abeff676a1120eb9c0f490075deeb3b0