title: Effect of sternotomy direction on the incidence of inadvertent pleurotomy.
abstract: OBJECTIVE
  Median sternotomy was performed by 2 different techniques in order to determine whether there was a difference in the incidence of inadvertent pleural entry.
  
  
  METHODS
  Patients were prospectively evaluated and reviewed at a mean follow-up interval of 8.2 months.
  
  
  METHODS
  Ninety five consecutive patients underwent primary sternotomy at a single tertiary referral center.
  
  
  METHODS
  Planned outcome measures included, incidence of pleural entry, length of hospitalization, and chest tube site related postoperative morbidity.
  
  
  RESULTS
  Group 1 (n=49) had sternotomy undertaken from the sternal notch proceeding downwards. Group 2 (n=46) underwent sternotomy performed from the xiphoid upwards. Mediastinal evaluation revealed a significant reduction in the incidence of pleural violation for group 1 (3) versus group 2 (11) (p=0.014). This difference was not found to be surgeon specific.
  
  
  CONCLUSIONS
  Sternotomy undertaken from the sternal notch proceeding downwards is shown to be associated with a reduced incidence of inadvertent pleural entry. Potential advantages for this approach also include reduced respiratory morbidity, less chest tube site complications and a trend to reduced length of hospitalization.
authors.affiliation: Department of Cardiac Surgery, Mayo Medical Center, Rochester, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Pick
authors.forename: J
authors.initials: J
authors.lastname: Dearani
authors.forename: J
authors.initials: J
authors.lastname: Odell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005500:Follow-Up Studies; D006491:Hemothorax / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D007902:Length of Stay; D055370:Lung Injury; D008875:Middle Aged; D010994:Pleura / Q000601:surgery*; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D011795:Surveys and Questionnaires